Provider Demographics
NPI:1053857052
Name:MACHIN, RAI (MA, LPC-INTERN)
Entity type:Individual
Prefix:
First Name:RAI
Middle Name:
Last Name:MACHIN
Suffix:
Gender:F
Credentials:MA, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 JUDSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3900
Mailing Address - Country:US
Mailing Address - Phone:903-241-2515
Mailing Address - Fax:903-220-0601
Practice Address - Street 1:1511 JUDSON RD STE C
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3900
Practice Address - Country:US
Practice Address - Phone:903-241-2515
Practice Address - Fax:903-220-0601
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76966101YM0800X, 101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor