MEDICARE: JESSICA MAE RODRIGUEZ M.S LPC ASSOCIATE

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	101YP2500X	Professional Counselor	97452	TX

General Provider Information

NPI Number	:	1932870516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MAE RODRIGUEZ M.S LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	633 E FERNHURST DR STE 304
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-1586
Country	:	US
Telephone Number	:	346-361-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8323 SOUTHWEST FWY STE 630
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1618
Country	:	US
Telephone Number	:	832-831-6178
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	02/04/2025

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