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General NPI Number Information
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NPI Number | 1497299010
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Entity Type | Individual
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Provider Name | MARK D ROGERS LMHC
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Gender | Male
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 500 W MAXWELL ST
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City | PENSACOLA
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State | FL
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Zip | 32501-1664
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Country | US
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Telephone | 850-426-6662
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Fax |
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Provider Business Mailing Address
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Address Line | 5860 SPANISH TRL APT F
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City | PENSACOLA
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State | FL
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Zip | 32504-5014
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Country | US
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Telephone | 850-426-6662
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13083
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License Number State | FL
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