Provider Demographics
NPI:1912490491
Name:CASEBOLT, RACHEL CAROLINE (LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CAROLINE
Last Name:CASEBOLT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W QUITMAN ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3833
Mailing Address - Country:US
Mailing Address - Phone:682-206-0202
Mailing Address - Fax:844-276-2121
Practice Address - Street 1:504 W QUITMAN ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3833
Practice Address - Country:US
Practice Address - Phone:682-206-0202
Practice Address - Fax:844-276-2121
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76546101YP2500X
ARP2202006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387327101Medicaid
AR289160719Medicaid