Provider Demographics
NPI:1528655172
Name:RHODES, FREDERICH L (MA)
Entity type:Individual
Prefix:
First Name:FREDERICH
Middle Name:L
Last Name:RHODES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 S CHELTON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1665
Mailing Address - Country:US
Mailing Address - Phone:719-231-9732
Mailing Address - Fax:
Practice Address - Street 1:1755 TELSTAR DR FL 3
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1016
Practice Address - Country:US
Practice Address - Phone:719-415-3558
Practice Address - Fax:719-960-3286
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional