Provider Demographics
NPI:1033444328
Name:GERALD ROGERS, M.A., M.S.W., PH.D., P.A.
Entity Type:Organization
Organization Name:GERALD ROGERS, M.A., M.S.W., PH.D., P.A.
Other - Org Name:WEST PINES ON GOLDEN POND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LPC
Authorized Official - Phone:806-354-9996
Mailing Address - Street 1:PO BOX 50660
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0660
Mailing Address - Country:US
Mailing Address - Phone:806-354-9996
Mailing Address - Fax:806-354-9991
Practice Address - Street 1:7480 GOLDEN POND PL
Practice Address - Street 2:SUITE 400
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1962
Practice Address - Country:US
Practice Address - Phone:806-354-9996
Practice Address - Fax:806-354-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2622101YP2500X
TX007321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154282OtherVALUE OPTIONS
TX064242301Medicaid
TX122754101OtherFIRST CARE
TX154282OtherVALUE OPTIONS