Provider Demographics
NPI:1417719907
Name:RHOADES, JENNA MACKENZIE (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MACKENZIE
Last Name:RHOADES
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3420
Mailing Address - Country:US
Mailing Address - Phone:817-707-7215
Mailing Address - Fax:
Practice Address - Street 1:3509 HULEN ST STE 108
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6800
Practice Address - Country:US
Practice Address - Phone:817-382-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health