Provider Demographics
NPI:1578789186
Name:ROGERS-SHARER, SHELLY LEIGH (PHD, LPC-S)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LEIGH
Last Name:ROGERS-SHARER
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-3432
Mailing Address - Country:US
Mailing Address - Phone:254-644-8267
Mailing Address - Fax:
Practice Address - Street 1:925 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-3432
Practice Address - Country:US
Practice Address - Phone:254-644-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20352101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180533503Medicaid
TX180533505Medicaid