Provider Demographics
NPI:1487374658
Name:WISE, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29607 STRAWBERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4003
Mailing Address - Country:US
Mailing Address - Phone:818-624-3675
Mailing Address - Fax:
Practice Address - Street 1:6300 E HAMPDEN AVE APT 3113
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7691
Practice Address - Country:US
Practice Address - Phone:818-624-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist