Provider Demographics
NPI:1710067640
Name:RODRIQUEZ, STELLA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:STELLA
Middle Name:
Last Name:RODRIQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 N O CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2427
Mailing Address - Country:US
Mailing Address - Phone:214-559-3773
Mailing Address - Fax:214-219-1120
Practice Address - Street 1:4038 LEMMON AVE
Practice Address - Street 2:STE 103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3736
Practice Address - Country:US
Practice Address - Phone:469-682-4145
Practice Address - Fax:214-219-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist