Provider Demographics
NPI:1982443271
Name:RACHEL COSTIN, LLC
Entity type:Organization
Organization Name:RACHEL COSTIN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:COSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:615-336-6373
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-0301
Mailing Address - Country:US
Mailing Address - Phone:615-270-1883
Mailing Address - Fax:
Practice Address - Street 1:201 THIRD AVE
Practice Address - Street 2:STE 105C
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664
Practice Address - Country:US
Practice Address - Phone:615-270-1883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health