Provider Demographics
NPI:1205057486
Name:ROGERS, CASEY PAUL (MA,MDIV,LPC)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:PAUL
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MA,MDIV,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 E. KEARNEY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802
Mailing Address - Country:US
Mailing Address - Phone:417-269-7254
Mailing Address - Fax:
Practice Address - Street 1:2032 E. KEARNEY
Practice Address - Street 2:SUITE 214
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802
Practice Address - Country:US
Practice Address - Phone:417-269-7254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003013934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional