Healthcare Provider Details

I. General information

NPI: 1497027312
Provider Name (Legal Business Name): HOWARD KENNETH ROGERS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N LEONA ST BLDG A, 3RD FLOOR
SAN ANTONIO TX
78207-3110
US

IV. Provider business mailing address

527 N LEONA ST BLDG A, 3RD FLOOR
SAN ANTONIO TX
78207-3110
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-9897
  • Fax: 210-358-9953
Mailing address:
  • Phone: 210-358-9897
  • Fax: 210-358-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: