Provider Demographics
NPI:1528831278
Name:BURGOYNE, RACHEL (LMFT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BURGOYNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CASTRO ST. #120 PMB 257
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041
Mailing Address - Country:US
Mailing Address - Phone:650-434-2521
Mailing Address - Fax:
Practice Address - Street 1:146 MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-2926
Practice Address - Country:US
Practice Address - Phone:650-434-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140923106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist