Provider Demographics
NPI:1972664142
Name:ROGERS, TERRY W (LPC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:W
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:MC KINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-4323
Mailing Address - Country:US
Mailing Address - Phone:214-213-0657
Mailing Address - Fax:972-548-1733
Practice Address - Street 1:205 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:MC KINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-4323
Practice Address - Country:US
Practice Address - Phone:214-213-0657
Practice Address - Fax:972-548-1733
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional