Provider Demographics
NPI:1073762480
Name:ROGERS, MICHELE LEE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 4490
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-4490
Mailing Address - Country:US
Mailing Address - Phone:707-442-2593
Mailing Address - Fax:
Practice Address - Street 1:822 G ST STE 12
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6223
Practice Address - Country:US
Practice Address - Phone:707-498-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78982106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist