Individual
RACHAEL EVONNE BOLANOS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TLMHC
Contact information
Practice address
4949 PLEASANT ST STE 202, WEST DES MOINES, IA 50266-5495
(515) 782-3208
Mailing address
4949 PLEASANT ST STE 202, WEST DES MOINES, IA 50266-5495
(515) 782-3208
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
117723
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117723
—
IA
Enumeration date
03/07/2023
Last updated
03/07/2023
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