MEDICARE: CARMEN G. RODRIGUEZ M.S., L.P.C.

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	101YP2500X	Professional Counselor	61491	TX
2	101YS0200X	School Counselor		TX

General Provider Information

NPI Number	:	1376778563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN G. RODRIGUEZ M.S., L.P.C.

Provider Business Mailing Address
First Line	:	3315 MIDLANDS CIR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-6461
Country	:	US
Telephone Number	:	956-222-0861
Fax Number	:

Provider Business Practice Location Address
First Line	:	5513 S SUGAR RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9644
Country	:	US
Telephone Number	:	956-782-8100
Fax Number	:

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

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	05/18/2009

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