Provider Demographics
NPI:1093269417
Name:RODRIGUEZ, NELSON (BACHELOR OF BEHAVIOR)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:BACHELOR OF BEHAVIOR
Other - Prefix:
Other - First Name:NELSON
Other - Middle Name:APOLO
Other - Last Name:RODRIGUEZ GUERRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 ELIZABETH RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANOTNIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253
Mailing Address - Country:US
Mailing Address - Phone:580-551-9053
Mailing Address - Fax:
Practice Address - Street 1:19965 FM 3175
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-3481
Practice Address - Country:US
Practice Address - Phone:830-276-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
TX84063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator