Healthcare Provider Details

I. General information

NPI: 1023778461
Provider Name (Legal Business Name): SHADEAU LEA RHODES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 TIMBER CREEK DR STE 4
CORDOVA TN
38018-4237
US

IV. Provider business mailing address

152 TIMBER CREEK DR STE 4
CORDOVA TN
38018-4237
US

V. Phone/Fax

Practice location:
  • Phone: 901-308-6991
  • Fax:
Mailing address:
  • Phone: 901-308-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11304
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7952
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: