Basic Information
| Provider Information | |||||||||
| NPI: | 1215070610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LAC 1183 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 74653 | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700334653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044107008 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3708 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELLE CHASSE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700373002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043935624 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 10/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PLPC | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 1183 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.