Provider Demographics
NPI:1023519089
Name:RODRIGUEZ, KEELY (LPC)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:
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 1:1534 E 6TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7239
Mailing Address - Country:US
Mailing Address - Phone:956-275-3232
Mailing Address - Fax:956-338-2994
Practice Address - Street 1:1534 E 6TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7239
Practice Address - Country:US
Practice Address - Phone:956-275-3232
Practice Address - Fax:956-338-2994
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TX78535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX78535OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS