1871769133 NPI number — MS. CHRISTIE THERESE ROGERS LPC LISAC

Table of content: MS. CHRISTIE THERESE ROGERS LPC LISAC (NPI 1871769133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871769133 NPI number — MS. CHRISTIE THERESE ROGERS LPC LISAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
CHRISTIE
Provider Middle Name:
THERESE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC LISAC
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:
1871769133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8070 N WILDOMAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85743-1180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-370-5926
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 N TOLTEC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELOY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85231-9680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-466-2353
Provider Business Practice Location Address Fax Number:
520-466-2399
Provider Enumeration Date:
05/06/2008

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: 101YP2500X , with the licence number:  LPC-1570 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 185182 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com