Healthcare Provider Details

I. General information

NPI: 1346746120
Provider Name (Legal Business Name): HARLOW M RHUDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLYN M CONLEY

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 VOLUNTEER PKWY
BRISTOL TN
37620-4652
US

IV. Provider business mailing address

1167 SPRATLIN PARK DR
GRAY TN
37615-6205
US

V. Phone/Fax

Practice location:
  • Phone: 423-989-4500
  • Fax: 423-899-4582
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9302
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: