Provider Demographics
NPI:1861545550
Name:RHODES, G. BLAIR (MFT)
Entity type:Individual
Prefix:
First Name:G. BLAIR
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:GEOFFREY
Other - Middle Name:BLAIR
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0122
Mailing Address - Country:US
Mailing Address - Phone:530-925-4480
Mailing Address - Fax:530-926-3450
Practice Address - Street 1:618 N MOUNT SHASTA BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2235
Practice Address - Country:US
Practice Address - Phone:530-925-4480
Practice Address - Fax:530-926-3450
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC#44077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist