Provider Demographics
NPI:1457170086
Name:RODRIGUEZ, GENEVIEVE ELENA
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ELENA
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 1:208 N BROADWAY STE 313
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1942
Mailing Address - Country:US
Mailing Address - Phone:406-545-0787
Mailing Address - Fax:406-412-0518
Practice Address - Street 1:208 N BROADWAY STE 313
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1942
Practice Address - Country:US
Practice Address - Phone:406-545-0787
Practice Address - Fax:406-412-0518
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-72602101YA0400X
MTBBH-PCLC-LIC-72603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)