Provider Demographics
NPI:1144996042
Name:POWELL, RACHEL JACLEEN (LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JACLEEN
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:JACLEEN
Other - Last Name:OETTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST STE P
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1601
Mailing Address - Country:US
Mailing Address - Phone:417-351-9418
Mailing Address - Fax:
Practice Address - Street 1:200 N MAIN ST STE P
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1868
Practice Address - Country:US
Practice Address - Phone:417-351-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health