Healthcare Provider Details

I. General information

NPI: 1316086028
Provider Name (Legal Business Name): JEREMY W RHOADES LMFT, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 G ST
EUREKA CA
95501-1828
US

IV. Provider business mailing address

904 G ST
EUREKA CA
95501-1829
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-2043
  • Fax:
Mailing address:
  • Phone: 707-269-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC53803
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: