Provider Demographics
NPI:1871590067
Name:RACHAL, KENNETH CHRIS (PHD, MP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHRIS
Last Name:RACHAL
Suffix:
Gender:M
Credentials:PHD, MP
Other - Prefix:DR
Other - First Name:K.
Other - Middle Name:CHRIS
Other - Last Name:RACHAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MP
Mailing Address - Street 1:142A RUE MARGUERITE
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6738
Mailing Address - Country:US
Mailing Address - Phone:985-625-0023
Mailing Address - Fax:985-625-0022
Practice Address - Street 1:142A RUE MARGUERITE
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6738
Practice Address - Country:US
Practice Address - Phone:985-625-0023
Practice Address - Fax:985-625-0022
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA895103G00000X, 103TC1900X
LAMP.0014103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1130354Medicaid
LA1130354Medicaid