Provider Demographics
NPI:1598709172
Name:ROGELL, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ROGELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 E MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1913
Mailing Address - Country:US
Mailing Address - Phone:517-372-2377
Mailing Address - Fax:517-372-2542
Practice Address - Street 1:2535 E MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-1913
Practice Address - Country:US
Practice Address - Phone:517-372-2377
Practice Address - Fax:517-372-2542
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001324101YM0800X
MI6301008175103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI61-45419OtherUNITED BEHAVIORAL HEALTH
MI038457OtherBLUE CARE NETWORK
MI680C312960OtherBCBS/MICHIGAN