Provider Demographics
NPI:1942699202
Name:ROGERS, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
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 1:7023A MEARS GATE DR NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8849
Mailing Address - Country:US
Mailing Address - Phone:330-497-2452
Mailing Address - Fax:330-497-2749
Practice Address - Street 1:7023A MEARS GATE DR NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8849
Practice Address - Country:US
Practice Address - Phone:330-497-2452
Practice Address - Fax:330-497-2749
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000181101YP2500X
OHF.1400020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist