Provider Demographics
NPI:1194047381
Name:ROGERS, OPHELIA N (MED LPC)
Entity type:Individual
Prefix:MRS
First Name:OPHELIA
Middle Name:N
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17595 E 1240 RD
Mailing Address - Street 2:
Mailing Address - City:ERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73645-4522
Mailing Address - Country:US
Mailing Address - Phone:580-414-0164
Mailing Address - Fax:580-225-1130
Practice Address - Street 1:120 S MADISON AVE STE 24
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5741
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:580-225-1130
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4115101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional