Provider Demographics
NPI:1710761093
Name:ROGERS, KATHRYN (BETH) (LAC)
Entity Type:Individual
Prefix:
First Name:KATHRYN (BETH)
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6922 SUMMER HILL CV
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6381
Mailing Address - Country:US
Mailing Address - Phone:479-957-5862
Mailing Address - Fax:
Practice Address - Street 1:6815 ISAACS ORCHARD RD STE B1
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6902
Practice Address - Country:US
Practice Address - Phone:479-957-5862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2009132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health