1265598478 NPI number — MRS. CASSY LYNN RHOADES M.A, L.P.C.

Table of content: MRS. CASSY LYNN RHOADES M.A, L.P.C. (NPI 1265598478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265598478 NPI number — MRS. CASSY LYNN RHOADES M.A, L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHOADES
Provider First Name:
CASSY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A, L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COCHRANE-RHOADES
Provider Other First Name:
CASANDA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., L.P.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265598478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75671-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-938-3160
Provider Business Mailing Address Fax Number:
903-938-7180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75670-3230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-938-3160
Provider Business Practice Location Address Fax Number:
903-938-7180
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  TX16259 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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