Provider Demographics
NPI:1245089663
Name:ROGERS, JOSIE ELANOR (AMFT)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:ELANOR
Last Name:ROGERS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:ELIZABETH
Other - Last Name:TAITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:672 E VINE ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5539
Mailing Address - Country:US
Mailing Address - Phone:435-731-9670
Mailing Address - Fax:
Practice Address - Street 1:672 E VINE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5539
Practice Address - Country:US
Practice Address - Phone:435-731-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13984623-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist