Provider Demographics
NPI:1407864580
Name:ROGERS, KAYE (LPC)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SYBIL LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1818
Mailing Address - Country:US
Mailing Address - Phone:903-596-8118
Mailing Address - Fax:903-596-8125
Practice Address - Street 1:2010 SYBIL LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1818
Practice Address - Country:US
Practice Address - Phone:903-596-8118
Practice Address - Fax:903-596-8125
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13085101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84706LOtherBCBS
TX095571803Medicaid