Healthcare Provider Details

I. General information

NPI: 1275893612
Provider Name (Legal Business Name): DEBORAH ANN ROGERS LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2012
Last Update Date: 09/20/2020
Certification Date: 09/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 W HARVARD AVE STE 427
ROSEBURG OR
97471
US

IV. Provider business mailing address

1813 W HARVARD AVE STE 427
ROSEBURG OR
97471-8712
US

V. Phone/Fax

Practice location:
  • Phone: 541-817-5326
  • Fax: 800-864-2539
Mailing address:
  • Phone: 541-817-5326
  • Fax: 800-864-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60275886
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCO P 933
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: