Provider Demographics
NPI:1992544118
Name:YOUNGMAN, RACHELLE NICOLE
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:NICOLE
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:NICOLE
Other - Last Name:HUNDAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 CROWN POINT CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:988 MCCOURTNEY RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-7400
Practice Address - Country:US
Practice Address - Phone:530-470-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist