Provider Demographics
NPI:1770321374
Name:RODRIGUEZ, KRISTA LEE
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 E EISTETTER ST APT 13
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5295
Mailing Address - Country:US
Mailing Address - Phone:956-337-3290
Mailing Address - Fax:
Practice Address - Street 1:1219 E EISTETTER ST APT 13
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5295
Practice Address - Country:US
Practice Address - Phone:956-337-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional