MEDICARE: KRISTIN TIMBERLAKE RODRIGUEZ MA, 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	18814	TX

General Provider Information

NPI Number	:	1710643853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN TIMBERLAKE RODRIGUEZ MA, LPC

Provider Business Mailing Address
First Line	:	3502 WILLOW RIDGE DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2658
Country	:	US
Telephone Number	:	832-995-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 ROCKMEAD DR STE 246
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2106
Country	:	US
Telephone Number	:	832-995-8166
Fax Number	:

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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