Provider Demographics
NPI:1588771208
Name:RODRIGUEZ, TRINIDAD P (LPC)
Entity type:Individual
Prefix:MS
First Name:TRINIDAD
Middle Name:P
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:TRINI
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1700 A RANCH RD. 12
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-2502
Mailing Address - Country:US
Mailing Address - Phone:512-396-7170
Mailing Address - Fax:512-754-7972
Practice Address - Street 1:205 CHEATHAM ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6859
Practice Address - Country:US
Practice Address - Phone:512-396-7170
Practice Address - Fax:512-754-7972
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3309LCOtherBCBS