Provider Demographics
NPI:1376778563
Name:RODRIGUEZ, CARMEN G (MS, LPC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:G
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:ALICIA
Other - Last Name:GAYTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3315 MIDLANDS CIR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6461
Mailing Address - Country:US
Mailing Address - Phone:956-222-0861
Mailing Address - Fax:
Practice Address - Street 1:5513 S SUGAR RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9644
Practice Address - Country:US
Practice Address - Phone:956-782-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61491101YP2500X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool