MEDICARE: RACHEL LAUREN TICE LCPC

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	101YP2500X	Professional Counselor	9850	ID

General Provider Information

NPI Number	:	1437767217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LAUREN TICE LCPC

Provider Business Mailing Address
First Line	:	101 S PARK AVE STE 206
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-3669
Country	:	US
Telephone Number	:	208-360-4923
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S PARK AVE STE 206
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-3669
Country	:	US
Telephone Number	:	208-360-4923
Fax Number	:

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

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	02/04/2025

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Directions to “ RACHEL LAUREN TICE LCPC” Practice Location

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