Provider Demographics
NPI:1598561458
Name:RODRIGUEZ, ELIJAH LUIS (MA, LPC-A)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:LUIS
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11775 CHERYL DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-5601
Mailing Address - Country:US
Mailing Address - Phone:903-952-2628
Mailing Address - Fax:
Practice Address - Street 1:11775 CHERYL DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-5601
Practice Address - Country:US
Practice Address - Phone:903-952-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty