Provider Demographics
NPI:1063374692
Name:ROGERS, BRIANNA MICHELLE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MICHELLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11771 MIRA LAGO BLVD APT 1206
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6473
Mailing Address - Country:US
Mailing Address - Phone:972-677-3017
Mailing Address - Fax:
Practice Address - Street 1:11771 MIRA LAGO BLVD APT 1206
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-6473
Practice Address - Country:US
Practice Address - Phone:972-677-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94368101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health