Provider Demographics
NPI:1699136390
Name:ROGERS, DIANE E (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 STARK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1570
Mailing Address - Country:US
Mailing Address - Phone:541-484-4881
Mailing Address - Fax:
Practice Address - Street 1:3413 STARK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1570
Practice Address - Country:US
Practice Address - Phone:541-484-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC #810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional