Provider Demographics
NPI:1093188500
Name:RODRIGUEZ, MEGHAN A (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 N 25TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6560
Mailing Address - Country:US
Mailing Address - Phone:970-424-4068
Mailing Address - Fax:
Practice Address - Street 1:1141 N 25TH ST STE C
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6560
Practice Address - Country:US
Practice Address - Phone:970-424-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000170701Medicaid