Healthcare Provider Details

I. General information

NPI: 1497271845
Provider Name (Legal Business Name): ESTEPHANIE RODRIGUEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 W 24TH ST STE 120
YUMA AZ
85364-8539
US

IV. Provider business mailing address

281 W 24TH ST STE 120
YUMA AZ
85364-8539
US

V. Phone/Fax

Practice location:
  • Phone: 928-247-6430
  • Fax:
Mailing address:
  • Phone: 928-247-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-16584
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: