Basic Information
| Provider Information | |||||||||
| NPI: | 1376874032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHYNES | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, LPC; SUBSTANCE A | ||||||||
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| Mailing Information | |||||||||
| Address1: | RESOURCE MANAGEMENT | ||||||||
| Address2: | 1300 HOPPE BLVD., SUITE 1 | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804367211 | ||||||||
| FaxNumber: | 5802725757 | ||||||||
| Practice Location | |||||||||
| Address1: | THE CHICKASAW NATION RECOVERY RESOURCE SERVICES | ||||||||
| Address2: | 1300 HOPPE BLVD. SUITE 6 | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804361222 | ||||||||
| FaxNumber: | 5802350559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 4918 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 100646580E | 05 | OK | MEDICAID |