Provider Demographics
NPI:1780763474
Name:ROGERS, JOHN PATRICK JR (LPCC (6291))
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:LPCC (6291)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26312 WHISPERING LEAVES DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2243
Mailing Address - Country:US
Mailing Address - Phone:330-687-2293
Mailing Address - Fax:661-235-7012
Practice Address - Street 1:23550 LYONS AVE STE 211
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-5745
Practice Address - Country:US
Practice Address - Phone:881-287-6145
Practice Address - Fax:661-235-7012
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04035101YA0400X
CA2989101YP2500X
CA6291101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1780763474Medicaid