Provider Demographics
NPI:1033647086
Name:ROGERS, NICOLETTE (LMHP, CPC, LPC, NCE)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMHP, CPC, LPC, NCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12351 W 96TH TER STE 105
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4410
Mailing Address - Country:US
Mailing Address - Phone:913-257-3161
Mailing Address - Fax:
Practice Address - Street 1:3805 OAKLAND AVE STE 101A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4902
Practice Address - Country:US
Practice Address - Phone:913-257-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2352101YM0800X
NE11175101YP2500X
NE2526101YP2500X
MO2019040496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health