Provider Demographics
NPI:1083826721
Name:WAHL, RODGER D (MED, LPC)
Entity type:Individual
Prefix:MR
First Name:RODGER
Middle Name:D
Last Name:WAHL
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 S. TEXAS BLVD. STE 116
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4868
Mailing Address - Country:US
Mailing Address - Phone:956-463-3431
Mailing Address - Fax:956-447-2221
Practice Address - Street 1:522 S. TEXAS BLVD STE 116
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4868
Practice Address - Country:US
Practice Address - Phone:956-463-3431
Practice Address - Fax:956-447-2221
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171413101Medicaid