Provider Demographics
NPI:1790121655
Name:RODRIGUE, ADRIAN JOY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:JOY
Last Name:RODRIGUE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2863 MILANO LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3273
Mailing Address - Country:US
Mailing Address - Phone:832-748-0608
Mailing Address - Fax:
Practice Address - Street 1:2225 COUNTY ROAD 90
Practice Address - Street 2:STE 107
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4890
Practice Address - Country:US
Practice Address - Phone:832-632-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11212014103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst