Provider Demographics
NPI:1295953156
Name:GERALD W ROGERS M.A.,M.S.W.,PHD,P.A.
Entity type:Organization
Organization Name:GERALD W ROGERS M.A.,M.S.W.,PHD,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PA
Authorized Official - Phone:806-354-9996
Mailing Address - Street 1:PO BOX 50660
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0660
Mailing Address - Country:US
Mailing Address - Phone:806-354-9996
Mailing Address - Fax:806-354-9995
Practice Address - Street 1:7480 GOLDEN POND SUITE 400
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121
Practice Address - Country:US
Practice Address - Phone:806-354-9996
Practice Address - Fax:806-354-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11662504OtherCAQH
TX1952499451OtherNPI