Provider Demographics
NPI:1518070911
Name:RHODES, MARILYN KAY (MS LMFT, LCSW,LPC)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:KAY
Last Name:RHODES
Suffix:
Gender:F
Credentials:MS LMFT, LCSW,LPC
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:KAY
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LMFT,LCSW,LPC
Mailing Address - Street 1:888 THACKERAY TR.
Mailing Address - Street 2:SUITE105
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-542-3255
Mailing Address - Fax:262-567-5451
Practice Address - Street 1:888 THACKERAY TRL STE 105
Practice Address - Street 2:888 THACKERAY TR. SUITE105
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:262-542-3255
Practice Address - Fax:262-567-5451
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI495125101YP2500X
WI38361231041C0700X
WI172124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39261600Medicaid