Provider Demographics
NPI:1679725063
Name:RODRIGUEZ, CHRISELDA LYNNETTE (LPA)
Entity Type:Individual
Prefix:
First Name:CHRISELDA
Middle Name:LYNNETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 WATER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5330
Mailing Address - Country:US
Mailing Address - Phone:830-258-5430
Mailing Address - Fax:830-792-5771
Practice Address - Street 1:1901 DUTTON DR STE D
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7574
Practice Address - Country:US
Practice Address - Phone:512-558-2004
Practice Address - Fax:512-396-4984
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34087103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34087OtherLPA LICENSE