Provider Demographics
NPI:1861524498
Name:BENTLEY, RACHEL LEE (MA)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LEE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-0083
Mailing Address - Country:US
Mailing Address - Phone:951-704-8788
Mailing Address - Fax:
Practice Address - Street 1:1300 N MILLER RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1000
Practice Address - Country:US
Practice Address - Phone:623-236-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50929106H00000X
AZLMFT-15246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9888OtherMEDI-CAL STAFF NUMBER