Provider Demographics
NPI:1164757886
Name:ROGERS, JESSICA LEIGH (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 STRADA CIR STE 108D
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3212
Mailing Address - Country:US
Mailing Address - Phone:817-475-1735
Mailing Address - Fax:817-394-1207
Practice Address - Street 1:990 HIGHWAY 287 N
Practice Address - Street 2:SUITE 106, #353
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2607
Practice Address - Country:US
Practice Address - Phone:817-475-1735
Practice Address - Fax:817-394-1207
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional