Provider Demographics
NPI:1336192426
Name:RODRIQUEZ, IRISTELA (LMFT)
Entity Type:Individual
Prefix:
First Name:IRISTELA
Middle Name:
Last Name:RODRIQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 RIVERSTONE BLVD STE 902
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5206
Mailing Address - Country:US
Mailing Address - Phone:281-778-8750
Mailing Address - Fax:281-778-8751
Practice Address - Street 1:4502 RIVERSTONE BLVD STE 902
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5206
Practice Address - Country:US
Practice Address - Phone:281-778-8750
Practice Address - Fax:281-778-8751
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX5151106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172769501Medicaid
TX8606BHOtherBCBS OF TX