Provider Demographics
NPI:1942050984
Name:RODRIGUEZ, SUSANA (MS, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-0733
Mailing Address - Country:US
Mailing Address - Phone:956-833-2687
Mailing Address - Fax:
Practice Address - Street 1:1606 VOLCANO AVE
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8210
Practice Address - Country:US
Practice Address - Phone:956-833-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health