Provider Demographics
NPI:1427135169
Name:ROGERS, PAMELA ANNE (LPCC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANNE
Other - Last Name:ROGERS-C'DE BACA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:159 CALLE OJO FELIZ
Mailing Address - Street 2:UNIT H
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5740
Mailing Address - Country:US
Mailing Address - Phone:505-660-0443
Mailing Address - Fax:505-983-6492
Practice Address - Street 1:4011 BARBARA LOOP SE
Practice Address - Street 2:SUITE 103
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1039
Practice Address - Country:US
Practice Address - Phone:505-891-1583
Practice Address - Fax:505-891-1768
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0089251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06763OtherLOVELACE HEALTH PLAN