Provider Demographics
NPI:1265855217
Name:ROGERS, JOHN GERON (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GERON
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S. HWY 27
Mailing Address - Street 2:STE N
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715
Mailing Address - Country:US
Mailing Address - Phone:352-348-8858
Mailing Address - Fax:352-414-4876
Practice Address - Street 1:506 S. HWY 27
Practice Address - Street 2:STE N
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715
Practice Address - Country:US
Practice Address - Phone:352-348-8858
Practice Address - Fax:352-414-4876
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH12251OtherLICENSED MENTAL HEALTH CON