Provider Demographics
NPI:1801931225
Name:RODGERS, TROY J (PSYD, LPCC)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:J
Last Name:RODGERS
Suffix:
Gender:M
Credentials:PSYD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92002
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-2002
Mailing Address - Country:US
Mailing Address - Phone:505-888-5499
Mailing Address - Fax:505-888-5498
Practice Address - Street 1:10409 MONTGOMERY PARKWAY W NE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-888-5499
Practice Address - Fax:505-888-5498
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0089061101YP2500X
NM304400103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90021240Medicaid