Healthcare Provider Details

I. General information

NPI: 1336059526
Provider Name (Legal Business Name): SAMANTHA CHRISTINE RHOADES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 E CREEK RD
BELOIT WI
53511-7916
US

IV. Provider business mailing address

3809 E CREEK RD
BELOIT WI
53511-7916
US

V. Phone/Fax

Practice location:
  • Phone: 618-570-4768
  • Fax:
Mailing address:
  • Phone: 618-570-4768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.017573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: