Active NPI
Mary Ruth Rodriguez, LPC
- Counselor
- Fort Worth, TX
National Provider Identifier
1578044335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 68990
- Practice address
- 1512 W Gambrell St
Fort Worth, TX 76115-2207 - Phone
- (817) 734-5331
- Fax
- (817) 924-0440
- NPI assigned
- Aug 28, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 68990 | TX | Primary |
Addresses
Primary practice location
1512 W Gambrell St
Fort Worth, TX 76115-2207
Mailing address
8313 Orleans LN
Fort Worth, TX 76123-1634
Phone (817) 501-5657
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 68990 | Other | TX | STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS |
Other names 1
- Mary Briseno Rodriguez
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 |
|---|---|---|---|
| 68990 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535414400000",
"number": "1578044335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8313 ORLEANS LN",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761231634",
"telephone_number": "817-501-5657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1512 W GAMBRELL ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761152207",
"telephone_number": "817-734-5331",
"fax_number": "817-924-0440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "MARY",
"middle_name": "RUTH",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-28",
"last_updated": "2018-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "68990",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS",
"identifier": "68990",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "RODRIGUEZ",
"middle_name": "BRISENO",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.