Doctor Name: | JORDENNE RACHELLE |
NPI Number: | 1427460823 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | |
Business Practice Address: | 133 Grove St Boulder Creek, CA - 950068910 |
Business Phone Number: | 4088297961 |
Business Fax Number: | |
Mailing Address: | 133 Grove St, BOULDER CREEK |
State: | CA |
Postal Code: | 950068910 |
Phone Number: | 4088297961 |
Fax Number: | |
NPI Enumeration Date: | 05/20/2014 |
NPI Last Update Date: | 05/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |