Provider Demographics
NPI:1639278435
Name:SANCHEZ-RODRIGUEZ, LOURDES M (LMHC)
Entity type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:M
Last Name:SANCHEZ-RODRIGUEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 SOMMER CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3224
Mailing Address - Country:US
Mailing Address - Phone:859-265-4425
Mailing Address - Fax:850-265-1811
Practice Address - Street 1:1606 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3653
Practice Address - Country:US
Practice Address - Phone:850-814-5060
Practice Address - Fax:850-248-7928
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811551600Medicaid
FL763657100Medicaid