Healthcare Provider Details

I. General information

NPI: 1164997920
Provider Name (Legal Business Name): BRITTNEY D RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 4TH ST
GILLETTE WY
82716-3330
US

IV. Provider business mailing address

5475 KNOLL PL
HIGHLANDS RANCH CO
80130-8044
US

V. Phone/Fax

Practice location:
  • Phone: 888-924-2366
  • Fax: 888-263-5638
Mailing address:
  • Phone: 888-924-2366
  • Fax: 888-263-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA3985
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: