MEDICARE: MS. RACHEL KIMBERLY LARRETA LMFT

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	106H00000X	Marriage & Family Therapist	202274	TX

General Provider Information

NPI Number	:	1619406600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL KIMBERLY LARRETA LMFT

Provider Business Mailing Address
First Line	:	1101 S CAPITAL OF TEXAS HWY STE A280
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6478
Country	:	US
Telephone Number	:	512-937-2904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S CAPITAL OF TEXAS HWY STE A280
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6478
Country	:	US
Telephone Number	:	512-937-2904
Fax Number	:

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

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	02/16/2018

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