Healthcare Provider Details

I. General information

NPI: 1659904316
Provider Name (Legal Business Name): ADAM ROGERS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12075 E HIGHWAY 69 STE A
DEWEY AZ
86327-4517
US

IV. Provider business mailing address

13110 E PONCE ST
DEWEY AZ
86327-7161
US

V. Phone/Fax

Practice location:
  • Phone: 928-830-1401
  • Fax: 928-447-9911
Mailing address:
  • Phone: 928-830-1401
  • Fax: 928-447-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ADAM ROGERS
Title or Position: PROVIDER/OWNER
Credential: LISAC
Phone: 928-830-1401