Provider Demographics
NPI:1790385052
Name:RANKIN, PHOEBE MIKELLE
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:MIKELLE
Last Name:RANKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FM 1460 APT 13205
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-4496
Mailing Address - Country:US
Mailing Address - Phone:623-755-2909
Mailing Address - Fax:
Practice Address - Street 1:2000 FM 1460 APT 13205
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4496
Practice Address - Country:US
Practice Address - Phone:623-755-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical