Provider Demographics
NPI:1396378691
Name:RODRIGUEZ, MELISSA MARES (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARES
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24610 GLASS CYN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-3515
Mailing Address - Country:US
Mailing Address - Phone:210-748-8874
Mailing Address - Fax:
Practice Address - Street 1:16607 BLANCO RD STE 502
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1910
Practice Address - Country:US
Practice Address - Phone:210-384-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional