MEDICARE: MARK EUGENE RHODES PSYD

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	103TC0700X	Clinical Psychologist	31891	TX

General Provider Information

NPI Number	:	1518919190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK EUGENE RHODES PSYD

Provider Business Mailing Address
First Line	:	12 MEDICAL DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-4136
Country	:	US
Telephone Number	:	806-356-0404
Fax Number	:	806-356-0590

Provider Business Practice Location Address
First Line	:	12 MEDICAL DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-4136
Country	:	US
Telephone Number	:	806-356-0404
Fax Number	:	806-356-0590

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/08/2012

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