Provider Demographics
NPI:1134951072
Name:VANCE, RACHEL JOAN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JOAN
Last Name:VANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:JOAN
Other - Last Name:BAGSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2946 BEULAH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ARRINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:37014-9124
Mailing Address - Country:US
Mailing Address - Phone:435-222-4881
Mailing Address - Fax:
Practice Address - Street 1:107 TWIN HILLS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2242
Practice Address - Country:US
Practice Address - Phone:615-513-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health