Provider Demographics
NPI:1881083491
Name:RHODES, KATHY JEAN (MA, LMHC, LPC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JEAN
Last Name:RHODES
Suffix:
Gender:F
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 W MARINE DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5821
Mailing Address - Country:US
Mailing Address - Phone:503-766-5380
Mailing Address - Fax:844-640-0665
Practice Address - Street 1:637 W MARINE DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-5821
Practice Address - Country:US
Practice Address - Phone:503-766-5380
Practice Address - Fax:844-640-0665
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7056101YM0800X
WALH60432642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health