Healthcare Provider Details

I. General information

NPI: 1295628006
Provider Name (Legal Business Name): MICHAEL ABRAHAM RODELA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 MONTANA AVE
EL PASO TX
79902-5668
US

IV. Provider business mailing address

201 E MAIN DR
EL PASO TX
79901-1340
US

V. Phone/Fax

Practice location:
  • Phone: 915-747-3510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: