Healthcare Provider Details

I. General information

NPI: 1013088319
Provider Name (Legal Business Name): MEGAN CARRICO ROGERS MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 02/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16607 BLANCO RD STE 904
SAN ANTONIO TX
78232-1942
US

IV. Provider business mailing address

9607 AVIARA GDNS
SAN ANTONIO TX
78251-5024
US

V. Phone/Fax

Practice location:
  • Phone: 210-428-5927
  • Fax: 877-734-2749
Mailing address:
  • Phone: 210-428-5927
  • Fax: 210-616-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: