Provider Demographics
NPI:1700360633
Name:RHOADES, KAYLEE RACQUEL (BA, MA)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RACQUEL
Last Name:RHOADES
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S HILL ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3506
Mailing Address - Country:US
Mailing Address - Phone:213-334-2814
Mailing Address - Fax:
Practice Address - Street 1:222 S HILL ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3506
Practice Address - Country:US
Practice Address - Phone:213-334-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127895106H00000X
171M00000X
CA142148106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator