Provider Demographics
NPI:1306315015
Name:MICU, RACHEL (MA, LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MICU
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-0386
Mailing Address - Country:US
Mailing Address - Phone:636-746-9285
Mailing Address - Fax:636-224-1784
Practice Address - Street 1:1360 S 5TH ST STE 306
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2447
Practice Address - Country:US
Practice Address - Phone:636-746-9285
Practice Address - Fax:636-224-1784
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018045597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional