Provider Demographics
NPI:1073053112
Name:RHYNES, MICHELLE FERNANDEZ
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FERNANDEZ
Last Name:RHYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N MACARTHUR BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4404
Mailing Address - Country:US
Mailing Address - Phone:469-844-0382
Mailing Address - Fax:
Practice Address - Street 1:3200 N MACARTHUR BLVD STE 101
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4404
Practice Address - Country:US
Practice Address - Phone:469-844-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201937106H00000X
TX69767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist