Provider Demographics
NPI:1346056488
Name:ROGERS, JAMES BRANDON (MED, LPC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRANDON
Last Name:ROGERS
Suffix:
Gender:M
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 1:4012 MUSCOVY DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5121
Mailing Address - Country:US
Mailing Address - Phone:817-793-4548
Mailing Address - Fax:
Practice Address - Street 1:4012 MUSCOVY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5121
Practice Address - Country:US
Practice Address - Phone:817-793-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional