Provider Demographics
NPI:1578662078
Name:RHOADS, REGINALD D (PLMHP)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:D
Last Name:RHOADS
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S BURLINGTON AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5904
Mailing Address - Country:US
Mailing Address - Phone:402-461-4917
Mailing Address - Fax:402-461-3404
Practice Address - Street 1:208 S BURLINGTON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5904
Practice Address - Country:US
Practice Address - Phone:402-461-4917
Practice Address - Fax:402-461-3404
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025352600Medicaid
NE98329OtherBLUE CROSS BLUE SHIELD