Doctor Name: | MRS. RAQUEL ANGELA KELLICUT |
NPI Number: | 1285642520 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | LCPC 137 |
Business Practice Address: | 1420 Lincoln Way Ste 500 Coeur D Alene, ID - 838142391 |
Business Phone Number: | 2086678474 |
Business Fax Number: | 2086655704 |
Mailing Address: | 1420 Lincoln Way Ste 500, COEUR D ALENE |
State: | ID |
Postal Code: | 838142391 |
Phone Number: | 2086678474 |
Fax Number: | 2086655704 |
NPI Enumeration Date: | 08/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | LCPC 137 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |