Provider Demographics
NPI:1295117992
Name:STUART, RODNEY (LCDC)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:
Last Name:STUART
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BARRANCA DR STE 800
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-5006
Mailing Address - Country:US
Mailing Address - Phone:915-782-4000
Mailing Address - Fax:915-782-4040
Practice Address - Street 1:10690 SOCORRO RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79927-2332
Practice Address - Country:US
Practice Address - Phone:915-858-6208
Practice Address - Fax:915-858-0435
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12071101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)