Healthcare Provider Details

I. General information

NPI: 1124003322
Provider Name (Legal Business Name): RHONDA S BLACKWELL-ALTHAGE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RHONDA S BLACKWELL

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 COUNTY RD 3610
ST. JAMES MO
65559
US

IV. Provider business mailing address

1060 E SPRINGFIELD RD
SULLIVAN MO
63080-1361
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-3251
  • Fax: 573-265-2508
Mailing address:
  • Phone: 314-541-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: