Provider Demographics
NPI:1710643853
Name:RODRIGUEZ, KRISTIN TIMBERLAKE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:TIMBERLAKE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:TIFFANY
Other - Last Name:TIMBERLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3502 WILLOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2658
Mailing Address - Country:US
Mailing Address - Phone:832-995-8166
Mailing Address - Fax:
Practice Address - Street 1:700 ROCKMEAD DR STE 246
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2106
Practice Address - Country:US
Practice Address - Phone:832-995-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional