Provider Demographics
NPI:1255527859
Name:RHINE, MARINELL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARINELL
Middle Name:
Last Name:RHINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 WARD ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1829
Mailing Address - Country:US
Mailing Address - Phone:303-278-7418
Mailing Address - Fax:888-341-5050
Practice Address - Street 1:239 IDAHO ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83211-1235
Practice Address - Country:US
Practice Address - Phone:208-226-7500
Practice Address - Fax:208-226-7501
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-8221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806983300Medicaid
ID806966600Medicaid
ID87-072-6551OtherTRICARE
IDL3761OtherBLUE CROSS
ID000010148188OtherBLUE SHIELD