Provider Demographics
NPI:1770517989
Name:RHODEN, BRETT LOWELL (MA)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:LOWELL
Last Name:RHODEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8382 BAYMEADOWS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7436
Mailing Address - Country:US
Mailing Address - Phone:904-699-8796
Mailing Address - Fax:904-880-4060
Practice Address - Street 1:8382 BAYMEADOWS RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7436
Practice Address - Country:US
Practice Address - Phone:904-699-8796
Practice Address - Fax:904-886-4646
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 0905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762100100Medicaid