Provider Demographics
NPI:1407600059
Name:RODRIGUEZ, JACOB (LMSW)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:606 SWANEE DR # 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3022
Mailing Address - Country:US
Mailing Address - Phone:512-766-3375
Mailing Address - Fax:
Practice Address - Street 1:606 SWANEE DR # 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3022
Practice Address - Country:US
Practice Address - Phone:512-766-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health