Provider Demographics
NPI:1407090830
Name:ROGERS, MICHAEL J (CASAC, LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:M
Credentials:CASAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 E KEARNEY ST STE 214
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4662
Mailing Address - Country:US
Mailing Address - Phone:417-869-0700
Mailing Address - Fax:417-869-0705
Practice Address - Street 1:2032 E KEARNEY ST STE 214
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4662
Practice Address - Country:US
Practice Address - Phone:417-869-0700
Practice Address - Fax:417-869-0705
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3275101YA0400X
MO2004035839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)