Provider Demographics
NPI:1801413562
Name:RODRIGUEZ, JACKLYN N (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:N
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 ENNIS JOSLIN RD APT 927
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4381
Mailing Address - Country:US
Mailing Address - Phone:361-633-1211
Mailing Address - Fax:
Practice Address - Street 1:1701 ENNIS JOSLIN RD APT 927
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4381
Practice Address - Country:US
Practice Address - Phone:361-633-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health