Provider Demographics
NPI:1902053895
Name:PETTYS, RACHEL B (LCAC, LPC-LPCC)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:B
Last Name:PETTYS
Suffix:
Gender:F
Credentials:LCAC, LPC-LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-6905
Mailing Address - Country:US
Mailing Address - Phone:701-253-3206
Mailing Address - Fax:701-253-3748
Practice Address - Street 1:2605 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2968
Practice Address - Country:US
Practice Address - Phone:701-253-3206
Practice Address - Fax:701-253-3748
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1582101YA0400X
ND1170-12-15-21-553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)