Provider Demographics
NPI:1306022546
Name:ROGERS, LEE ANN
Entity Type:Individual
Prefix:MS
First Name:LEE ANN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 E AVENUE D
Mailing Address - Street 2:SUITE F
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2284
Mailing Address - Country:US
Mailing Address - Phone:254-547-6415
Mailing Address - Fax:254-547-2030
Practice Address - Street 1:806 E AVENUE D
Practice Address - Street 2:SUITE F
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2284
Practice Address - Country:US
Practice Address - Phone:254-547-6415
Practice Address - Fax:254-547-2030
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical