Provider Demographics
NPI:1972692804
Name:ROGERS, LYNNEE CHANTEL (MS, LCPC)
Entity type:Individual
Prefix:
First Name:LYNNEE
Middle Name:CHANTEL
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:LYNNEE
Other - Middle Name:FRIBERG
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LCPC
Mailing Address - Street 1:849 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1806
Mailing Address - Country:US
Mailing Address - Phone:208-546-9395
Mailing Address - Fax:208-795-8611
Practice Address - Street 1:849 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1806
Practice Address - Country:US
Practice Address - Phone:208-546-9395
Practice Address - Fax:208-795-8611
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-4591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8P901OtherBLUE CROSS
ID20-1-12583OtherBPA
IDX6893 GROUP 8J745OtherBLUE CROSS