Basic Information
| Provider Information | |||||||||
| NPI: | 1568188399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISP | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | MAY | ||||||||
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| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | MAY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1305 TACOMA AVE S STE 201 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984021903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533965823 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1201 SOUTH PR0CTOR ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533965823 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2022 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.