Provider Demographics
NPI:1679699763
Name:ROGERS, NYLA LOUISE (MFT)
Entity Type:Individual
Prefix:MS
First Name:NYLA
Middle Name:LOUISE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27539 TULA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1332
Mailing Address - Country:US
Mailing Address - Phone:661-430-0303
Mailing Address - Fax:
Practice Address - Street 1:311 E. AVENUE K 4
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:91353
Practice Address - Country:US
Practice Address - Phone:661-726-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 46602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist