Provider Demographics
NPI:1275893612
Name:ROGERS, DEBORAH ANN (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 W HARVARD AVE STE 427
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8712
Mailing Address - Country:US
Mailing Address - Phone:541-817-5326
Mailing Address - Fax:800-864-2539
Practice Address - Street 1:1813 W HARVARD AVE STE 427
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-817-5326
Practice Address - Fax:800-864-2539
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60275886101YM0800X
AKPCO P 933101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid
OR500733657Medicaid
AKPCOP933OtherSTATE OF ALASKA-BOARD OF PROFESSIONAL COUNSELORS
ORC4751OtherSTATE OF OREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS
WALH60275886OtherWASHINGTON STATE DEPARTMENT OF HEALTH-MENTAL HEALTH COUNSELOR LICENSE