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General NPI Number Information
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NPI Number | 1710802046
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Entity Type | Individual
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Provider Name | ROSE RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 4841 MERLOT AVE UNIT 420
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City | GRAPEVINE
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State | TX
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Zip | 76051-7382
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Country | US
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Telephone | 817-809-8399
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 BRIAR ST
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City | PORTLAND
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State | TX
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Zip | 78374-2206
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Country | US
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Telephone | 361-816-5236
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 102982
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License Number State | TX
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