Individual provider Active NPI

Jack Rodriguez

  • Professional Counselor
  • Rochester Hills, MI
National Provider Identifier
1992323281
Registry record updated Aug 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401018434 Issued in MI
Practice address
1955 W Hamlin Rd Ste 101
Rochester Hills, MI 48309-3338
Phone
(248) 301-6455
NPI assigned
Jul 13, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401018434 MI Primary

Addresses

Primary practice location

1955 W Hamlin Rd Ste 101
Rochester Hills, MI 48309-3338

Mailing address

1955 W Hamlin Rd Ste 101
Rochester Hills, MI 48309-3338
Phone (586) 926-6437

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250528002642 MI Practitioner - Mental Health Counselor 3072032481 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401018434MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Counseling Center Mental Health CurrentSince Dec 1, 2024 Accepting new patients
Root & Bloom Therapy PLLC Professional CurrentSince May 16, 2025 Accepting new patients

Locations

42627 Garfield Rd
Ste 217
Clinton Twp, MI 48038
Phone (586) 203-2715

1955 W Hamlin Rd
Ste 101
Rochester Hills, MI 48309
Phone (248) 301-6455

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755129600000",
    "number": "1992323281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1955 W HAMLIN RD STE 101",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483093338",
            "telephone_number": "586-926-6437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1955 W HAMLIN RD STE 101",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483093338",
            "telephone_number": "248-301-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "JACK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-13",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401018434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

Verify at the official NPI Registry.