Provider Demographics
NPI:1821363664
Name:ROBERTS, RACHELLE EILEEN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:EILEEN
Last Name:ROBERTS
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 1:50660 EISENHOWER DR APT 622
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2332
Mailing Address - Country:US
Mailing Address - Phone:760-601-5260
Mailing Address - Fax:
Practice Address - Street 1:44175 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-6801
Practice Address - Country:US
Practice Address - Phone:760-200-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA79989OtherLMFT