Provider Demographics
NPI:1043991557
Name:RODRIGUEZ, AGUSTIN (LMFT 122485)
Entity Type:Individual
Prefix:MR
First Name:AGUSTIN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMFT 122485
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W FOOTHILL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3786
Mailing Address - Country:US
Mailing Address - Phone:909-985-0513
Mailing Address - Fax:909-985-7193
Practice Address - Street 1:1126 W FOOTHILL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3786
Practice Address - Country:US
Practice Address - Phone:909-985-0513
Practice Address - Fax:909-985-7193
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health