MEDICARE: MIGNON 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467824862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGNON RODRIGUEZ

Provider Business Mailing Address
First Line	:	6600 S HARVEY PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-7314
Country	:	US
Telephone Number	:	405-503-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 S HARVEY PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-7314
Country	:	US
Telephone Number	:	405-503-5656
Fax Number	:

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

Provider Enumeration Date	:	10/24/2015
Last Update Date	:	10/24/2015

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Directions to “ MIGNON RODRIGUEZ ” Practice Location

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