Provider Demographics
NPI:1033453659
Name:WHITEHEAD, RACHAEL A (LPC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:WHITEHEAD
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 1:3712 MANCHACA RD APT 10
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6778
Mailing Address - Country:US
Mailing Address - Phone:512-567-9002
Mailing Address - Fax:512-858-4223
Practice Address - Street 1:800 W HIGHWAY 290
Practice Address - Street 2:BUILDING A, SUITE 100
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4191
Practice Address - Country:US
Practice Address - Phone:512-567-9002
Practice Address - Fax:512-858-4223
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health