Provider Demographics
NPI:1497115067
Name:RHOADES, MICHAEL JEROME (CADC III, NCC, CTMH,)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEROME
Last Name:RHOADES
Suffix:
Gender:M
Credentials:CADC III, NCC, CTMH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3966 S PACIFIC HWY SPC 75
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-9020
Mailing Address - Country:US
Mailing Address - Phone:541-292-0870
Mailing Address - Fax:
Practice Address - Street 1:600 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2140
Practice Address - Country:US
Practice Address - Phone:541-625-1159
Practice Address - Fax:541-603-4482
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-10-01101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)