MEDICARE: JENNA MACKENZIE RHOADES LPC-ASSOCIATE

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	92324	TX

General Provider Information

NPI Number	:	1417719907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MACKENZIE RHOADES LPC-ASSOCIATE

Provider Business Mailing Address
First Line	:	4206 FOX HOLLOW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-3420
Country	:	US
Telephone Number	:	817-707-7215
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 HULEN ST STE 108
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6800
Country	:	US
Telephone Number	:	817-382-7130
Fax Number	:

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

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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