1720576978 NPI number — RACHEL KATE AUSTIN LMFT CANDIDATE

Table of content: RACHEL KATE AUSTIN LMFT CANDIDATE (NPI 1720576978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720576978 NPI number — RACHEL KATE AUSTIN LMFT CANDIDATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTIN
Provider First Name:
RACHEL
Provider Middle Name:
KATE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT CANDIDATE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBERDS
Provider Other First Name:
RACHEL
Provider Other Middle Name:
KATE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT CANDIDATE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720576978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 PROFESSIONAL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUKON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73099-6470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-265-3444
Provider Business Mailing Address Fax Number:
405-577-5488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1707 PROFESSIONAL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUKON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73099-6470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-265-3444
Provider Business Practice Location Address Fax Number:
405-577-5488
Provider Enumeration Date:
04/24/2018

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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