Healthcare Provider Details

I. General information

NPI: 1316711765
Provider Name (Legal Business Name): TAYLOR RENEE ROGERS MA, LCPC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CLEARWOOD CT
SAINT PETERS MO
63376-4689
US

IV. Provider business mailing address

210 CLEARWOOD CT
SAINT PETERS MO
63376-4689
US

V. Phone/Fax

Practice location:
  • Phone: 314-254-3573
  • Fax:
Mailing address:
  • Phone: 309-846-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025020627
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180016426
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: