Provider Demographics
NPI:1073762480
Name:ROGERS, MICHELE LEE (MFTI)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:JACQUENETTE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:3172 WALFORD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4898
Mailing Address - Country:US
Mailing Address - Phone:707-442-2593
Mailing Address - Fax:
Practice Address - Street 1:3172 WALFORD AVE STE 2
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503
Practice Address - Country:US
Practice Address - Phone:707-442-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78982106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist