Provider Demographics
NPI:1487199600
Name:BURQUE, RACHELLE (LMHC-QS)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:BURQUE
Suffix:
Gender:F
Credentials:LMHC-QS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W BAY AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4125
Mailing Address - Country:US
Mailing Address - Phone:407-801-4846
Mailing Address - Fax:
Practice Address - Street 1:231 W BAY AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4125
Practice Address - Country:US
Practice Address - Phone:407-801-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health