Healthcare Provider Details

I. General information

NPI: 1740972900
Provider Name (Legal Business Name): MICHAEL AARON ROGERS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 W DICKMAN RD STE P1
SPRINGFIELD MI
49037-4895
US

IV. Provider business mailing address

300 W FERRY ST
BERRIEN SPRINGS MI
49103-1109
US

V. Phone/Fax

Practice location:
  • Phone: 269-883-6560
  • Fax:
Mailing address:
  • Phone: 269-815-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012639
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: