Healthcare Provider Details

I. General information

NPI: 1316166390
Provider Name (Legal Business Name): MARIAH LYNN RHODES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAH LYNN MUNSTEDT

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E SHORT AVE
SPOKANE WA
99202-1555
US

IV. Provider business mailing address

107 S DIVISION ST
SPOKANE WA
99202-1510
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4651
  • Fax:
Mailing address:
  • Phone: 509-838-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60011789
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-3273
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: