Healthcare Provider Details

I. General information

NPI: 1992912612
Provider Name (Legal Business Name): LAURICE DIANE ROGERS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 S 3RD ST
LOUISVILLE KY
40203-2901
US

IV. Provider business mailing address

105 TERRI ROSE CT
HODGENVILLE KY
42748-9774
US

V. Phone/Fax

Practice location:
  • Phone: 502-581-1258
  • Fax:
Mailing address:
  • Phone: 270-358-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0043
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number060018
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: