Provider Demographics
NPI:1225726557
Name:PAVLOV, RACHEL RENEE (LPC, LCDC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:RENEE
Last Name:PAVLOV
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N CORINTH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5444
Mailing Address - Country:US
Mailing Address - Phone:940-448-0304
Mailing Address - Fax:
Practice Address - Street 1:1400 N CORINTH ST STE 109
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5444
Practice Address - Country:US
Practice Address - Phone:940-448-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90531101YM0800X
TX16312101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)