Basic Information
| Provider Information | |||||||||
| NPI: | 1316283203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHOADES | ||||||||
| FirstName: | ELTON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 S LEXINGTON WAY | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730124223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053155464 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 527 NW 23RD ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731031515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056068676 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2012 | ||||||||
| LastUpdateDate: | 12/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | OK | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.