Provider Demographics
NPI:1902684244
Name:ROGERS, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W MAIN ST STE 213
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2166
Mailing Address - Country:US
Mailing Address - Phone:385-316-8311
Mailing Address - Fax:435-579-9491
Practice Address - Street 1:24 W MAIN ST STE 213
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2166
Practice Address - Country:US
Practice Address - Phone:385-316-8311
Practice Address - Fax:435-579-9491
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
UT13998803-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health