1275893612 NPI number — DEBORAH ANN ROGERS LPC, LMHC

Table of content: DEBORAH ANN ROGERS LPC, LMHC (NPI 1275893612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275893612 NPI number — DEBORAH ANN ROGERS LPC, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
DEBORAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275893612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1813 W HARVARD AVE STE 427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97471-8712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-817-5326
Provider Business Mailing Address Fax Number:
800-864-2539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1813 W HARVARD AVE STE 427
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-817-5326
Provider Business Practice Location Address Fax Number:
800-864-2539
Provider Enumeration Date:
05/19/2012

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: 101YM0800X , with the licence number:  LH 60275886 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: PCO P 933 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1020986 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500733657 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: PCOP933 . This is a "STATE OF ALASKA-BOARD OF PROFESSIONAL COUNSELORS" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: C4751 . This is a "STATE OF OREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: LH60275886 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH-MENTAL HEALTH COUNSELOR LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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