Basic Information
| Provider Information | |||||||||
| NPI: | 1255778999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | JESUS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6800 PARK TEN BLVD STE 200S | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782134293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102611000 | ||||||||
| FaxNumber: | 2102611821 | ||||||||
| Practice Location | |||||||||
| Address1: | 928 W COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782074444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102611250 | ||||||||
| FaxNumber: | 2104340716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | 343354 | NM | N | Behavioral Health & Social Service Providers | Counselor | School | 101YA0400X | 60256647 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 60296838 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YS0200X | 485664G | WA | N | Behavioral Health & Social Service Providers | Counselor | School | 101YS0200X | 86119 | MT | N | Behavioral Health & Social Service Providers | Counselor | School | 101YP2500X | 80992 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.