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General NPI Number Information
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NPI Number | 1225702046
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Entity Type | Individual
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Provider Name | JONATHAN DAVID RODIS LPC
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Gender | Male
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 6768 E SAN CRISTOBAL WAY
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City | GOLD CANYON
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State | AZ
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Zip | 85118-1898
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Country | US
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Telephone | 602-361-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 6768 E SAN CRISTOBAL WAY
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City | GOLD CANYON
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State | AZ
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Zip | 85118-1898
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Country | US
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Telephone | 602-361-6888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-19286
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License Number State | AZ
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