Provider Demographics
NPI:1720633886
Name:RODRIGUEZ, TERESA (MCMHC, LPC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MCMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13439 BROADWAY EXT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2256
Mailing Address - Country:US
Mailing Address - Phone:405-456-9004
Mailing Address - Fax:
Practice Address - Street 1:13439 BROADWAY EXT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2256
Practice Address - Country:US
Practice Address - Phone:405-456-9004
Practice Address - Fax:405-607-1750
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator