Provider Demographics
NPI:1497299010
Name:ROGERS, MARK D (LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 SPANISH TRL APT F
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5014
Mailing Address - Country:US
Mailing Address - Phone:850-426-6662
Mailing Address - Fax:
Practice Address - Street 1:500 W MAXWELL ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1664
Practice Address - Country:US
Practice Address - Phone:850-426-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH13083OtherFLORIDA MQA BOARD (491 BOARD)