MEDICARE: RACHEL MICU MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2018045597	MO
2	101YP2500X	Professional Counselor	2018045597	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306315015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MICU MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 386
Second Line	:
City	:	IMPERIAL
State	:	MO
Zip	:	63052-0386
Country	:	US
Telephone Number	:	636-746-9285
Fax Number	:	636-224-1784

Provider Business Practice Location Address
First Line	:	1360 S 5TH ST STE 306
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2447
Country	:	US
Telephone Number	:	636-746-9285
Fax Number	:	636-224-1784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	05/21/2026

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