Healthcare Provider Details

I. General information

NPI: 1962500389
Provider Name (Legal Business Name): NADINE D, RHODES-MARSH LPAE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT POLK LA
71459-5102
US

IV. Provider business mailing address

P.O. BOX 877
NEW LLANO LA
71461-0887
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3922
  • Fax: 337-531-3760
Mailing address:
  • Phone: 337-531-3772
  • Fax: 337-531-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number555
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: