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General NPI Number Information
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NPI Number | 1568107639
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Entity Type | Individual
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Provider Name | JEREMY MICHAEL RHOADES
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Gender | Male
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 8939 RED CLOUD ROAD
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City | FORT RUCKER
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State | AL
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Zip | 36362
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Country | US
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Telephone | 334-255-3447
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Fax |
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Provider Business Mailing Address
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Address Line | 404 E SOMMER OAK DR
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City | ENTERPRISE
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State | AL
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Zip | 36330-8558
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Country | US
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Telephone | 808-892-0565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | A312
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C4003A
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License Number State | AL
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