Provider Demographics
NPI:1992932834
Name:MURRELL, RACHEL (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MURRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 FAIRFAX AVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4939
Mailing Address - Country:US
Mailing Address - Phone:502-424-7017
Mailing Address - Fax:
Practice Address - Street 1:130 FAIRFAX AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4939
Practice Address - Country:US
Practice Address - Phone:502-424-7017
Practice Address - Fax:888-512-5102
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3555104100000X
KYKY-35551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100295350Medicaid
KYK078750Medicare PIN