Active NPI
Agustin Rodriguez, LMFT 122485
- Mental Health Counselor
- Upland, CA
National Provider Identifier
1043991557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 122485
- Practice address
- 1126 W Foothill Blvd Ste 110
Upland, CA 91786-3786 - Phone
- (909) 985-0513
- Fax
- (909) 985-7193
- NPI assigned
- Jul 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 122485 | CA | Primary |
Addresses
Primary practice location
1126 W Foothill Blvd Ste 110
Upland, CA 91786-3786
Mailing address
1126 W Foothill Blvd Ste 110
Upland, CA 91786-3786
Phone (909) 985-0513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122485 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samaritan Counseling Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Upland, CA
- NPI 1366572968
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1043991557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1126 W FOOTHILL BLVD STE 110",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863786",
"telephone_number": "909-985-0513",
"fax_number": "909-985-7193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1126 W FOOTHILL BLVD STE 110",
"city": "UPLAND",
"state": "CA",
"postal_code": "917863786",
"telephone_number": "909-985-0513",
"fax_number": "909-985-7193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "AGUSTIN",
"name_prefix": "Mr.",
"credential": "LMFT 122485",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-27",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "122485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.