Provider Demographics
NPI:1275356602
Name:HAYNES, RACHEL RENEE (LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:RENEE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 N GREEN BAY AVE UPPR LEVEL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3811
Mailing Address - Country:US
Mailing Address - Phone:414-247-0801
Mailing Address - Fax:
Practice Address - Street 1:6025 N GREEN BAY AVE UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3811
Practice Address - Country:US
Practice Address - Phone:414-247-0801
Practice Address - Fax:414-247-0816
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional