Healthcare Provider Details

I. General information

NPI: 1225036338
Provider Name (Legal Business Name): AMY ELIZABETH ROGERS M.S. LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH DIEFENDERFER LMFT

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 SEYMOUR AVE
CHEYENNE WY
82001-3159
US

IV. Provider business mailing address

2526 SEYMOUR AVE
CHEYENNE WY
82001-3159
US

V. Phone/Fax

Practice location:
  • Phone: 307-634-9653
  • Fax:
Mailing address:
  • Phone: 307-634-9653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT# 095
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: