Provider Demographics
NPI:1043240195
Name:RHODES, THERESA LYNN (LMSW, LISW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LYNN
Last Name:RHODES
Suffix:
Gender:F
Credentials:LMSW, LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2239
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2239
Mailing Address - Country:US
Mailing Address - Phone:505-553-2969
Mailing Address - Fax:
Practice Address - Street 1:245 CAMINO SIN PASADA
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8539
Practice Address - Country:US
Practice Address - Phone:505-553-2969
Practice Address - Fax:505-890-8480
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-058751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47474866Medicaid
NM343533301Medicare ID - Type Unspecified
NMOTH000Medicare UPIN