Provider Demographics
NPI:1235130964
Name:POLAKOFF, RHONDA JOY (PHD)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:JOY
Last Name:POLAKOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26231 E US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-7101
Mailing Address - Country:US
Mailing Address - Phone:214-876-5778
Mailing Address - Fax:
Practice Address - Street 1:26231 E US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-7101
Practice Address - Country:US
Practice Address - Phone:214-876-5778
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-5796103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113365402Medicaid
TX86669AOtherBCBS