MEDICARE: BENNETT RACHAL MS

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	19000	FL

General Provider Information

NPI Number	:	1770013237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENNETT RACHAL MS

Provider Business Mailing Address
First Line	:	1623 TROTTERS BEND TRL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5519
Country	:	US
Telephone Number	:	904-753-7757
Fax Number	:

Provider Business Practice Location Address
First Line	:	6108 ARLINGTON RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5420
Country	:	US
Telephone Number	:	904-569-6499
Fax Number	:

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

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	05/06/2022

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