Provider Demographics
NPI:1114757358
Name:ROGERS, JAIME FOWLKES (LPC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:FOWLKES
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4864 WOODRUFF WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1353
Mailing Address - Country:US
Mailing Address - Phone:972-838-6022
Mailing Address - Fax:
Practice Address - Street 1:5899 PRESTON RD STE 1102
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9594
Practice Address - Country:US
Practice Address - Phone:214-307-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health