Provider Demographics
NPI:1396808044
Name:RHODES, KATHLEEN M (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:RHODES
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WATERBURY DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-8200
Mailing Address - Country:US
Mailing Address - Phone:318-424-5008
Mailing Address - Fax:318-741-9964
Practice Address - Street 1:1002 HIGHLAND AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4143
Practice Address - Country:US
Practice Address - Phone:318-424-5008
Practice Address - Fax:318-741-9964
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2350101YP2500X
LA516106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH3045OtherBCBS