Provider Demographics
NPI:1437767217
Name:TICE, RACHEL LAUREN (LCPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAUREN
Last Name:TICE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S PARK AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3669
Mailing Address - Country:US
Mailing Address - Phone:208-360-4923
Mailing Address - Fax:
Practice Address - Street 1:101 S PARK AVE STE 206
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3669
Practice Address - Country:US
Practice Address - Phone:208-360-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional