Provider Demographics
NPI:1417103755
Name:RODRIGUEZ, LUIS JAVIER (MFT)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:JAVIER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-0233
Mailing Address - Country:US
Mailing Address - Phone:916-509-2778
Mailing Address - Fax:209-745-6626
Practice Address - Street 1:2830 I ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4311
Practice Address - Country:US
Practice Address - Phone:916-509-2778
Practice Address - Fax:209-745-6626
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAMFC52744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health