Provider Demographics
NPI:1003196841
Name:RODRIGUEZ, STACY ANN LYNCH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN LYNCH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 351
Mailing Address - Street 2:
Mailing Address - City:EVANT
Mailing Address - State:TX
Mailing Address - Zip Code:76525
Mailing Address - Country:US
Mailing Address - Phone:254-716-2035
Mailing Address - Fax:
Practice Address - Street 1:758 COUNTY ROAD 417
Practice Address - Street 2:
Practice Address - City:EVANT
Practice Address - State:TX
Practice Address - Zip Code:76525
Practice Address - Country:US
Practice Address - Phone:254-716-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50551171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator