Provider Demographics
NPI:1760170559
Name:GOMEZ, RAQUEL (LAMFT, LPC)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LAMFT, LPC
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12807 KINAID STREET
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607
Mailing Address - Country:US
Mailing Address - Phone:208-546-8130
Mailing Address - Fax:
Practice Address - Street 1:16150 N HIGH DESERT ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687
Practice Address - Country:US
Practice Address - Phone:208-546-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6561871101YP2500X
IDLAMFT-9316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist