Provider Demographics
NPI:1073027371
Name:MELANIE B ROGERS LLC
Entity Type:Organization
Organization Name:MELANIE B ROGERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-290-7210
Mailing Address - Street 1:748 FAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4060
Mailing Address - Country:US
Mailing Address - Phone:304-290-7210
Mailing Address - Fax:304-381-2456
Practice Address - Street 1:748 FAIRMONT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-4060
Practice Address - Country:US
Practice Address - Phone:304-290-7210
Practice Address - Fax:304-381-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2265-3303261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)