Provider Demographics
NPI:1376820142
Name:RODRIGUEZ, JEFFREY RENE (LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RENE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 N FOREST BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3303
Mailing Address - Country:US
Mailing Address - Phone:210-838-3470
Mailing Address - Fax:
Practice Address - Street 1:6726 N FOREST BND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3303
Practice Address - Country:US
Practice Address - Phone:210-838-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional