1811231301 NPI number — RACHEL A PEHRSON LCSW, CASAC

Table of content: RACHEL A PEHRSON LCSW, CASAC (NPI 1811231301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811231301 NPI number — RACHEL A PEHRSON LCSW, CASAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEHRSON
Provider First Name:
RACHEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CASAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRASSBERG
Provider Other First Name:
RACHEL
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811231301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3205 N ACADEMY BLVD STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80917-5152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-632-5700
Provider Business Mailing Address Fax Number:
719-344-7865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 PRINTERS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80910-3190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-632-5700
Provider Business Practice Location Address Fax Number:
719-344-7870
Provider Enumeration Date:
11/21/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW.09926388 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)