Provider Demographics
NPI:1114285574
Name:GORDON-ELDRED, RACHEL (MFT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GORDON-ELDRED
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:CASSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4382 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1013
Mailing Address - Country:US
Mailing Address - Phone:858-366-2198
Mailing Address - Fax:
Practice Address - Street 1:2257 BIRDS NEST LN
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1955
Practice Address - Country:US
Practice Address - Phone:858-366-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health