Provider Demographics
NPI:1629730155
Name:ROGERS MENTAL HEALTH AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:ROGERS MENTAL HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-970-8393
Mailing Address - Street 1:1200 N RED ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-8005
Mailing Address - Country:US
Mailing Address - Phone:479-970-8393
Mailing Address - Fax:
Practice Address - Street 1:OLD DOLLARWAY ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-7160
Practice Address - Country:US
Practice Address - Phone:479-970-7981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty