Provider Demographics
NPI:1841518750
Name:RODRIGUEZ, LORIE LYNN (LCDC)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:LYNN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7119
Mailing Address - Country:US
Mailing Address - Phone:512-786-8811
Mailing Address - Fax:512-986-7740
Practice Address - Street 1:7703 N LAMAR BLVD
Practice Address - Street 2:STE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1027
Practice Address - Country:US
Practice Address - Phone:512-206-4213
Practice Address - Fax:512-206-4286
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10427101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)