Individual
MARY RUTH RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1512 W GAMBRELL ST, FORT WORTH, TX 76115-2207
(817) 734-5331
(817) 924-0440
Mailing address
8313 ORLEANS LN, FORT WORTH, TX 76123-1634
(817) 501-5657
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
68990
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68990
STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
TX
Enumeration date
08/28/2018
Last updated
08/28/2018
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