Provider Demographics
NPI:1568172609
Name:RODGERS, BOBBY
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:RODGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5723 WHITTIER BLVD MELA COUNSELING SERVICES CENTER INC
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:213-721-6855
Mailing Address - Fax:
Practice Address - Street 1:5723 WHITTIER BLVD MELA COUNSELING SERVICES CENTER INC
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:213-721-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACADTP11339101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)