Provider Demographics
NPI:1013562396
Name:ROGERS, PRISCILLA DENISE (LCSW, LMHP, RPT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:DENISE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW, LMHP, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 SORENSEN PKWY
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-2139
Mailing Address - Country:US
Mailing Address - Phone:402-502-9788
Mailing Address - Fax:
Practice Address - Street 1:6659 SORENSEN PKWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2139
Practice Address - Country:US
Practice Address - Phone:402-502-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1677101YM0800X
VA0904009612101YM0800X
NE4863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health