Provider Demographics
NPI:1407879919
Name:RHODES, ROBERT L (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:RHODES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 S BOWN WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5456
Mailing Address - Country:US
Mailing Address - Phone:208-900-8500
Mailing Address - Fax:208-286-2686
Practice Address - Street 1:3152 S BOWN WAY STE 105
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5456
Practice Address - Country:US
Practice Address - Phone:208-900-8500
Practice Address - Fax:208-286-2686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID351981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH6875Medicaid