Provider Demographics
NPI:1043870546
Name:YOUNGDAHL, RACHEL (MED, BCBA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:YOUNGDAHL
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 E WHITING AVE # D
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4112
Mailing Address - Country:US
Mailing Address - Phone:714-397-9612
Mailing Address - Fax:
Practice Address - Street 1:7727 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2475
Practice Address - Country:US
Practice Address - Phone:800-807-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-36590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst