MEDICARE: MADISON ELIZABETH RHODES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	89644	TX

General Provider Information

NPI Number	:	1366245193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON ELIZABETH RHODES

Provider Business Mailing Address
First Line	:	110 MILL WOOD DR
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-3689
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5209 HERITAGE AVE STE 210
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-5997
Country	:	US
Telephone Number	:	817-545-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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