Provider Demographics
NPI:1588659700
Name:ROGERS, SUSAN M (MA,LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 MIDWESTERN PKWY
Mailing Address - Street 2:STE. 212
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2335
Mailing Address - Country:US
Mailing Address - Phone:940-696-0181
Mailing Address - Fax:940-696-5692
Practice Address - Street 1:2301 MIDWESTERN PKWY
Practice Address - Street 2:STE. 212
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2335
Practice Address - Country:US
Practice Address - Phone:940-696-0181
Practice Address - Fax:940-696-5692
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC12902101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2948LCOtherBCBS PROVIDER ID
TXLPC 12902OtherTEXAS STATE LICENSE