Provider Demographics
NPI:1902240450
Name:RODRIGUEZ, MARISOL M (PSYCHOTHERAPIST, CFI)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST, CFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10370 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5117
Mailing Address - Country:US
Mailing Address - Phone:720-257-1639
Mailing Address - Fax:720-420-6565
Practice Address - Street 1:954 NORTH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3419
Practice Address - Country:US
Practice Address - Phone:720-257-1639
Practice Address - Fax:720-420-6565
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0103222101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor