Provider Demographics
NPI:1003191826
Name:RODRIGUEZ MORENO, RITA A (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:A
Last Name:RODRIGUEZ MORENO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12274 BANDERA RD
Mailing Address - Street 2:SUITE 238
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4385
Mailing Address - Country:US
Mailing Address - Phone:210-838-5514
Mailing Address - Fax:
Practice Address - Street 1:12274 BANDERA RD
Practice Address - Street 2:SUITE 238
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4385
Practice Address - Country:US
Practice Address - Phone:210-838-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional