Healthcare Provider Details

I. General information

NPI: 1144771544
Provider Name (Legal Business Name): ANITA ROGERS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12416 TROUT CIR
SPRING HILL FL
34609-4964
US

IV. Provider business mailing address

12416 TROUT CIR
SPRING HILL FL
34609-4964
US

V. Phone/Fax

Practice location:
  • Phone: 360-813-8785
  • Fax:
Mailing address:
  • Phone: 360-813-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60705561
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: