Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 0091511 | NM |
N | 101YM0800X | Mental Health Counselor | CCMH0134511 | NM |
Y | 101YP2500X | Professional Counselor | CCMH0134511 | NM |
N | 101YS0200X | School Counselor | 316734 | NM |
N | 102L00000X | Psychologist | 316734 | NM |
N | 103T00000X | Psychologist | 316734 | NM |
N | 103G00000X | Clinical Psychologist | CCMH0134511 | NM |
N | 103TC0700X | Clinical Psychologist | CCMH0134511 | NM |
N | 103TC1900X | Counseling Psychologist | 316734 | NM |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 316734 | NM |
N | 103TP2701X | Group Psychotherapist | 316734 | NM |
N | 103TR0400X | Rehabilitation Psychologist | 316734 | NM |
N | 103TS0200X | School Psychologist | 316734 | NM |
NPI | 1699912055 |
---|---|
Provider Name | Patricia Dolores Rodriguez |
First Address | Las Vegas, NM 87701-4956 |
Second Address | Las Vegas, NM 87701-4956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90524071 | (05) | NM |