MEDICARE: RACHEL ELIZABETH SPRUILL LSW,MED

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker		PA
3	1041C0700X	Clinical Social Worker	106088	TX

General Provider Information

NPI Number	:	1588193064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ELIZABETH SPRUILL LSW,MED

Provider Business Mailing Address
First Line	:	5401 CHIMNEY ROCK RD APT 351
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2021
Country	:	US
Telephone Number	:	313-377-0247
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 CHIMNEY ROCK RD APT 351
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2021
Country	:	US
Telephone Number	:	313-377-0247
Fax Number	:

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	08/02/2022

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