=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518417187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE RHITMUS GROUP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2016
-----------------------------------------------------
Last Update Date | 10/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 S 14TH ST STE 140
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76065-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-612-5225
-----------------------------------------------------
Fax | 817-549-5449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 S 14TH ST STE 140
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76065-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-612-5225
-----------------------------------------------------
Fax | 817-549-5449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONSULTING COUNSELOR
-----------------------------------------------------
Name | MS. KIMBERLY A MENDOZA
-----------------------------------------------------
Credential | MS, LPC I
-----------------------------------------------------
Telephone | 469-612-5225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 71060
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------