Provider Demographics
NPI:1013088319
Name:ROGERS, MEGAN CARRICO (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CARRICO
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 AVIARA GDNS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-5024
Mailing Address - Country:US
Mailing Address - Phone:210-428-5927
Mailing Address - Fax:210-616-0845
Practice Address - Street 1:16607 BLANCO RD STE 904
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1942
Practice Address - Country:US
Practice Address - Phone:210-428-5927
Practice Address - Fax:877-734-2749
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64550101YP2500X
OHE-0008297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional