MEDICARE: RHONDA GENAE PATRICK LCSW-S, PHD

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	1041C0700X	Clinical Social Worker	26644	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	26644	TX
3	101YM0800X	Mental Health Counselor	26644	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26644	OTHER	TX	SOCIAL WORK LICENSE

General Provider Information

NPI Number	:	1366718157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA GENAE PATRICK LCSW-S, PHD

Provider Business Mailing Address
First Line	:	2631 GATTIS SCHOOL RD
Second Line	:	STE 455
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2969
Country	:	US
Telephone Number	:	713-397-9098
Fax Number	:

Provider Business Practice Location Address
First Line	:	2631 GATTIS SCHOOL RD STE 440
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2822
Country	:	US
Telephone Number	:	512-368-2809
Fax Number	:

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

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	05/02/2025

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