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1114088291

NPI Code Detail

MEDICARE: MARY TERESA RODRIGUES LPCC/LADAC

MEDICARE: MARY TERESA RODRIGUES LPCC/LADAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAD0163871	NM
2	101YM0800X	Mental Health Counselor	0120871	NM
3	101YP2500X	Professional Counselor	1106 LCPC	MT
4	101YP2500X	Professional Counselor	CCMH0120871	NM

General Provider Information

NPI Number	:	1114088291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY TERESA RODRIGUES LPCC/LADAC

Provider Business Mailing Address
First Line	:	4730 BECKNER RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3691
Country	:	US
Telephone Number	:	59-894-5005
Fax Number	:	54-438-3135

Provider Business Practice Location Address
First Line	:	4730 BECKNER RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3691
Country	:	US
Telephone Number	:	505-989-4500
Fax Number	:	505-443-8313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/07/2025

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Directions to “ MARY TERESA RODRIGUES LPCC/LADAC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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