Provider Demographics
NPI:1619954484
Name:ROGERS, HILLIARD R (LMFT)
Entity Type:Individual
Prefix:MR
First Name:HILLIARD
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 BRADSHAW RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2615
Mailing Address - Country:US
Mailing Address - Phone:916-368-2127
Mailing Address - Fax:916-363-3327
Practice Address - Street 1:3336 BRADSHAW RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2615
Practice Address - Country:US
Practice Address - Phone:916-368-2127
Practice Address - Fax:916-363-3327
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM18559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM18559Medicare UPIN