Healthcare Provider Details

I. General information

NPI: 1164757605
Provider Name (Legal Business Name): TIMOTHY ROGERS M.A.,LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20617 W HAMILTON ST
BUCKEYE AZ
85396-7772
US

IV. Provider business mailing address

20617 W HAMILTON ST
BUCKEYE AZ
85396-7772
US

V. Phone/Fax

Practice location:
  • Phone: 424-202-9269
  • Fax: 424-877-1759
Mailing address:
  • Phone: 424-202-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAZLMFT15993
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCALMFT101500
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCALMFT101500
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAZLMFT15993
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: