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General NPI Number Information
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NPI Number | 1033444328
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Entity Type | Organization
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Legal Business Name | GERALD ROGERS, M.A., M.S.W., PH.D., P.A.
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 7480 GOLDEN POND PL SUITE 400
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City | AMARILLO
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State | TX
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Zip | 79121-1962
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Country | US
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Telephone | 806-354-9996
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Fax | 806-354-9995
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Provider Business Mailing Address
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Address Line | PO BOX 50660
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City | AMARILLO
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State | TX
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Zip | 79159-0660
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Country | US
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Telephone | 806-354-9996
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Fax | 806-354-9991
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Authorized Official
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Title or Position | OWNER
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Name | GERALD W ROGERS
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Credential | LCSW, LPC
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Telephone | 806-354-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2622
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 00732
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License Number State | TX
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