Individual
MRS. RACHEL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
381 SHOUP AVE STE 202, IDAHO FALLS, ID 83402-3651
(208) 497-1290
Mailing address
440 TIE BREAKER DR, AMMON, ID 83406-4526
(208) 497-1290
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-9662
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165979709
—
ID
Enumeration date
06/18/2017
Last updated
10/23/2025
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