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General NPI Number Information
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NPI Number | 1265629679
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Entity Type | Individual
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Provider Name | DANA MARIE RODRIGUEZ LPC
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Gender | Female
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Dates
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Enumeration Date | 09/29/2007
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 249 W THORNHILL DR
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City | FORT WORTH
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State | TX
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Zip | 76115-2621
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Country | US
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Telephone | 817-534-0814
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Fax | 817-575-8779
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Provider Business Mailing Address
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Address Line | 249 W THORNHILL DR
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City | FORT WORTH
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State | TX
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Zip | 76115-2621
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Country | US
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Telephone | 817-534-0814
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Fax | 817-575-8779
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 15212
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License Number State | TX
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