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General NPI Number Information
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NPI Number | 1417719105
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Entity Type | Individual
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Provider Name | MAHAILY ROGERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 8140 N MOPAC EXPY BLDG 2 SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78759
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Country | US
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Telephone | 432-266-0190
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Fax |
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Provider Business Mailing Address
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Address Line | 4515 FELICITY LN
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City | AUSTIN
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State | TX
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Zip | 78725-3929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 104563
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License Number State | TX
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