Provider Demographics
NPI:1780047753
Name:RODGERS, CHRISELDA LUNA (BS QMHP)
Entity type:Individual
Prefix:MRS
First Name:CHRISELDA
Middle Name:LUNA
Last Name:RODGERS
Suffix:
Gender:F
Credentials:BS QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3412 TEAS NURSERY RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4614
Mailing Address - Country:US
Mailing Address - Phone:281-467-0636
Mailing Address - Fax:832-747-7800
Practice Address - Street 1:3412 TEAS NURSERY RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4614
Practice Address - Country:US
Practice Address - Phone:281-467-0636
Practice Address - Fax:832-747-7800
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical