Provider Demographics
NPI:1104057678
Name:RHOADES, TERRANCE WOODROW (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:WOODROW
Last Name:RHOADES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 MONTEVERDE LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-4315
Mailing Address - Country:US
Mailing Address - Phone:916-560-3275
Mailing Address - Fax:
Practice Address - Street 1:1321 HOWE AVE STE 212
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3365
Practice Address - Country:US
Practice Address - Phone:916-990-7211
Practice Address - Fax:916-560-3575
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-02
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22605103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104057678OtherNPI