Provider Demographics
NPI:1518138130
Name:PEVOTO, RODNEY (MED LPC, NCC)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:PEVOTO
Suffix:
Gender:M
Credentials:MED LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 APPALACHIAN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2821
Mailing Address - Country:US
Mailing Address - Phone:817-800-2833
Mailing Address - Fax:
Practice Address - Street 1:118 W HEARD ST
Practice Address - Street 2:SUITE D
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3836
Practice Address - Country:US
Practice Address - Phone:817-800-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193987801Medicaid