Provider Demographics
NPI:1982244505
Name:RODRIGUEZ-BLASH, SYITA TARRE (LMFTA)
Entity type:Individual
Prefix:
First Name:SYITA
Middle Name:TARRE
Last Name:RODRIGUEZ-BLASH
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 NW 171ST ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7420
Mailing Address - Country:US
Mailing Address - Phone:316-214-8773
Mailing Address - Fax:
Practice Address - Street 1:11901 N MACARTHUR BLVD STE D3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1855
Practice Address - Country:US
Practice Address - Phone:405-492-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-11
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist