Healthcare Provider Details

I. General information

NPI: 1881314987
Provider Name (Legal Business Name): CHRISTOPHER RODRIGUEZ MSW, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS RODRIGUEZ MSW, LMSW

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 PARK GROVE DR STE A
KATY TX
77450-5591
US

IV. Provider business mailing address

PO BOX 79874
HOUSTON TX
77279-9874
US

V. Phone/Fax

Practice location:
  • Phone: 800-685-9796
  • Fax: 281-676-4444
Mailing address:
  • Phone: 832-331-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103641
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: