Provider Demographics
NPI:1336890581
Name:ROGERS, ALYSSA DIANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:DIANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:DIANNE
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6120 SYDNEY CIR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9273
Mailing Address - Country:US
Mailing Address - Phone:208-800-8286
Mailing Address - Fax:
Practice Address - Street 1:718 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4104
Practice Address - Country:US
Practice Address - Phone:208-800-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional