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NPI Code Detail

MEDICARE: MRS. JENNIFER DIANE RODRIGUEZ

MEDICARE: MRS. JENNIFER DIANE RODRIGUEZ
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
1101YM0800XMental Health Counselor6217OK

General Provider Information

NPI Number : 1356763510
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER DIANE RODRIGUEZ
Provider Business Mailing Address
First Line : 10026 S MINGO RD # A-207
Second Line :
City : TULSA
State : OK
Zip : 74133-5714
Country : US
Telephone Number : 918-407-9803
Fax Number :
Provider Business Practice Location Address
First Line : 10026 S MINGO RD # A-207
Second Line :
City : TULSA
State : OK
Zip : 74133-5714
Country : US
Telephone Number : 918-407-9803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2014
Last Update Date : 08/21/2025

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Directions to “ MRS. JENNIFER DIANE RODRIGUEZ ” Practice Location

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