Provider Demographics
NPI:1659037620
Name:ROGG, SHALENE (LPC-S)
Entity Type:Individual
Prefix:
First Name:SHALENE
Middle Name:
Last Name:ROGG
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12640 N 2ND PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5404
Mailing Address - Country:US
Mailing Address - Phone:785-430-8830
Mailing Address - Fax:
Practice Address - Street 1:70 N MCCLINTOCK DR STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3711
Practice Address - Country:US
Practice Address - Phone:480-464-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-20422OtherSTATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS