Provider Demographics
NPI:1972736858
Name:ROGERS, LISA MACDOWELL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MACDOWELL
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MACDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:23099 COUNTY ROAD 3197 S
Mailing Address - Street 2:
Mailing Address - City:MT ENTERPRISE
Mailing Address - State:TX
Mailing Address - Zip Code:75681-6432
Mailing Address - Country:US
Mailing Address - Phone:903-263-9001
Mailing Address - Fax:
Practice Address - Street 1:23099 COUNTY ROAD 3197 S
Practice Address - Street 2:
Practice Address - City:MT ENTERPRISE
Practice Address - State:TX
Practice Address - Zip Code:75681-6432
Practice Address - Country:US
Practice Address - Phone:903-263-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical