Provider Demographics
NPI:1902009038
Name:ROGERS-VAUGHN, S. BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:S.
Middle Name:BRUCE
Last Name:ROGERS-VAUGHN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 VIRGINIA WAY
Mailing Address - Street 2:UNIT A-11
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7519
Mailing Address - Country:US
Mailing Address - Phone:615-969-3083
Mailing Address - Fax:615-371-8117
Practice Address - Street 1:5123 VIRGINIA WAY
Practice Address - Street 2:UNIT A-11
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7519
Practice Address - Country:US
Practice Address - Phone:615-969-3083
Practice Address - Fax:615-371-8117
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000034101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral