MEDICARE: MIRNA MARTELL RODRIGUEZ

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	106H00000X	Marriage & Family Therapist	204133	TX

General Provider Information

NPI Number	:	1699459289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRNA MARTELL RODRIGUEZ

Provider Business Mailing Address
First Line	:	12333 SOWDEN RD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-2059
Country	:	US
Telephone Number	:	832-953-4805
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 SOUTHWEST FYW SUITE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4520
Country	:	US
Telephone Number	:	832-953-4805
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	10/10/2025

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