Provider Demographics
NPI:1982989620
Name:BLAIR RHODES MFT
Entity Type:Organization
Organization Name:BLAIR RHODES MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-925-4480
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0122
Mailing Address - Country:US
Mailing Address - Phone:530-925-4480
Mailing Address - Fax:530-926-3450
Practice Address - Street 1:618 N MOUNT SHASTA BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2235
Practice Address - Country:US
Practice Address - Phone:530-925-4480
Practice Address - Fax:530-926-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44077251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health