Provider Demographics
NPI:1629205331
Name:RODRIGUEZ, ROY G (MFT)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:G
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 1:666 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-4119
Mailing Address - Country:US
Mailing Address - Phone:805-649-1229
Mailing Address - Fax:
Practice Address - Street 1:402 W OJAI AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2406
Practice Address - Country:US
Practice Address - Phone:805-649-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 12897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist