MEDICARE: MR. HECTOR RODRIGUEZ M.A., LLPC

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	101Y00000X	Counselor	6401010932	MI
2	101YM0800X	Mental Health Counselor	6401010932	MI

General Provider Information

NPI Number	:	1356676324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HECTOR RODRIGUEZ M.A., LLPC

Provider Business Mailing Address
First Line	:	4341 S WESTNEDGE AVE
Second Line	:	SUITE 2109
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-3289
Country	:	US
Telephone Number	:	269-341-9300
Fax Number	:	269-384-8448

Provider Business Practice Location Address
First Line	:	4341 S WESTNEDGE AVE
Second Line	:	SUITE 2109
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-3289
Country	:	US
Telephone Number	:	269-341-9300
Fax Number	:	269-384-8448

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

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/08/2009

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