Provider Demographics
NPI:1396252607
Name:RHODES, ROBERTA L (MA, MDIV)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:L
Last Name:RHODES
Suffix:
Gender:F
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 JOURNEYVILLE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-1762
Mailing Address - Country:US
Mailing Address - Phone:512-899-1267
Mailing Address - Fax:
Practice Address - Street 1:1004 MO PAC CIR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6805
Practice Address - Country:US
Practice Address - Phone:512-270-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional