Provider Demographics
NPI:1538377932
Name:RAINWATER, MYSTI RACHELLE (LPC)
Entity type:Individual
Prefix:
First Name:MYSTI
Middle Name:RACHELLE
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MYSTI
Other - Middle Name:RACHELLE
Other - Last Name:VANAKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:11011 S 48TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1779
Mailing Address - Country:US
Mailing Address - Phone:480-223-8263
Mailing Address - Fax:480-632-9639
Practice Address - Street 1:11011 S 48TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1779
Practice Address - Country:US
Practice Address - Phone:480-223-8263
Practice Address - Fax:480-632-9639
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional