MEDICARE: JEANNETTE RODRIGUEZ MS, LPC

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	83755	TX

General Provider Information

NPI Number	:	1497418727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE RODRIGUEZ MS, LPC

Provider Business Mailing Address
First Line	:	9115 FM 723 RD STE 550
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-9238
Country	:	US
Telephone Number	:	832-417-6647
Fax Number	:	832-415-0502

Provider Business Practice Location Address
First Line	:	9115 FM 723 RD STE 550
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-9238
Country	:	US
Telephone Number	:	832-417-6647
Fax Number	:	832-415-0502

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

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	06/10/2024

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