| Doctor Name: | SHASTA SKYLER RAEL |
| NPI Number: | 1023254091 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 0118461 |
| Business Practice Address: | 1100 W. 21st Clovis, NM - 88101 |
| Business Phone Number: | 5757422620 |
| Business Fax Number: | |
| Mailing Address: | 1100 W. 21st, CLOVIS |
| State: | NM |
| Postal Code: | 88101 |
| Phone Number: | 5757692345 |
| Fax Number: | 5757699031 |
| NPI Enumeration Date: | 12/22/2008 |
| NPI Last Update Date: | 03/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0118461 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |