Provider Demographics
NPI:1407523459
Name:SHOCKLEY, RACHEL (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17573 COUNTY ROAD 501
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-8713
Mailing Address - Country:US
Mailing Address - Phone:970-444-2190
Mailing Address - Fax:
Practice Address - Street 1:17573 COUNTY ROAD 501
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-8713
Practice Address - Country:US
Practice Address - Phone:970-903-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.09929763104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker