Provider Demographics
NPI:1316005408
Name:ROGERS, BRANDI LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEIGH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LEIGH
Other - Last Name:TRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHPP
Mailing Address - Street 1:PO BOX 10323
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72812-0323
Mailing Address - Country:US
Mailing Address - Phone:479-567-5654
Mailing Address - Fax:479-567-5661
Practice Address - Street 1:3101 W 2ND CT
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4504
Practice Address - Country:US
Practice Address - Phone:479-567-5654
Practice Address - Fax:479-567-5661
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2697-M104100000X
171M00000X
AR5470-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator