Provider Demographics
NPI:1821007139
Name:RHODES, JAN LANELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:LANELLE
Last Name:RHODES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4479
Mailing Address - Country:US
Mailing Address - Phone:936-564-4064
Mailing Address - Fax:936-564-1570
Practice Address - Street 1:903 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4479
Practice Address - Country:US
Practice Address - Phone:936-564-4064
Practice Address - Fax:936-564-1570
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80706LOtherBC/BS