1528350295 NPI number — MRS. SHELLY HOULE RODRIGUEZ LCMHC, LADC

Table of content: MRS. SHELLY HOULE RODRIGUEZ LCMHC, LADC (NPI 1528350295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528350295 NPI number — MRS. SHELLY HOULE RODRIGUEZ LCMHC, LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
SHELLY
Provider Middle Name:
HOULE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCMHC, LADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOULE
Provider Other First Name:
SHELLY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LADC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528350295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
272 NORTH MAINE STREET
Provider Second Line Business Mailing Address:
ROOM # 223
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-644-1460
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 UPPER PLEASANT VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-324-4803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  000482 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 0680057754 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)