Provider Demographics
NPI:1134138738
Name:RODRIGUEZ, MICHELLE (LPCC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JUAN TABO NE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3984
Mailing Address - Country:US
Mailing Address - Phone:505-275-6405
Mailing Address - Fax:505-275-6405
Practice Address - Street 1:3900 JUAN TABO NE
Practice Address - Street 2:SUITE 12
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-8934
Practice Address - Country:US
Practice Address - Phone:505-275-6405
Practice Address - Fax:505-275-6405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG3981Medicaid