Provider Demographics
NPI:1457375131
Name:ROLLIN RHODES AND ASSOCIATES
Entity Type:Organization
Organization Name:ROLLIN RHODES AND ASSOCIATES
Other - Org Name:ELIZABETHTOWN PSYCHOLOGISTS PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLLIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:270-765-6709
Mailing Address - Street 1:915 MEMORIAL CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2525
Mailing Address - Country:US
Mailing Address - Phone:270-765-6709
Mailing Address - Fax:270-769-3779
Practice Address - Street 1:915 MEMORIAL CT
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2525
Practice Address - Country:US
Practice Address - Phone:270-765-6709
Practice Address - Fax:270-769-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0076Medicare PIN