Provider Demographics
NPI:1730660655
Name:VAN TASSEL, RACHAEL A (LPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:VAN TASSEL
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11427 FOREST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-8744
Mailing Address - Country:US
Mailing Address - Phone:607-222-4184
Mailing Address - Fax:
Practice Address - Street 1:30-32 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2304
Practice Address - Country:US
Practice Address - Phone:570-282-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional