Provider Demographics
NPI:1851736128
Name:ROGERS, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3100
Mailing Address - Country:US
Mailing Address - Phone:918-696-5536
Mailing Address - Fax:918-696-5397
Practice Address - Street 1:106 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3100
Practice Address - Country:US
Practice Address - Phone:918-696-5536
Practice Address - Fax:918-696-5397
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health