Healthcare Provider Details

I. General information

NPI: 1609896356
Provider Name (Legal Business Name): BEVERLY J RODGERS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44426 10TH ST W
LANCASTER CA
93534-3325
US

IV. Provider business mailing address

44426 10TH ST W
LANCASTER CA
93534-3325
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-0530
  • Fax: 661-940-0591
Mailing address:
  • Phone: 661-940-0530
  • Fax: 661-940-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC32850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: