=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568243418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMANUEL RODRIGUEZ MFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2023
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2062 TALBERT DR STE 100
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95928-7718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-431-8074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 539 GREEN ST
-----------------------------------------------------
City | WILLOWS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95988-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-570-4643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------