Provider Demographics
NPI:1518919190
Name:RHODES, MARK EUGENE (PSYD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EUGENE
Last Name:RHODES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4136
Mailing Address - Country:US
Mailing Address - Phone:806-356-0404
Mailing Address - Fax:806-356-0590
Practice Address - Street 1:12 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4136
Practice Address - Country:US
Practice Address - Phone:806-356-0404
Practice Address - Fax:806-356-0590
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB162741Medicare PIN