Basic Information
| Provider Information | |||||||||
| NPI: | 1316088545 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOLEY | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | DANIELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KENAGA | ||||||||
| OtherFirstName: | RACHAEL | ||||||||
| OtherMiddleName: | DANIELLE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA, LLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 679 | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490850679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699852000 | ||||||||
| FaxNumber: | 2699852002 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490851426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699852000 | ||||||||
| FaxNumber: | 2699852002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 02/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 6301013387 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.