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General NPI Number Information
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NPI Number | 1710761093
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Entity Type | Individual
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Provider Name | KATHRYN (BETH) ROGERS LAC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 6815 ISAACS ORCHARD RD STE B1
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City | SPRINGDALE
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State | AR
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Zip | 72762-6902
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Country | US
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Telephone | 479-957-5862
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Fax |
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Provider Business Mailing Address
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Address Line | 6922 SUMMER HILL CV
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City | SPRINGDALE
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State | AR
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Zip | 72762-6381
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Country | US
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Telephone | 479-957-5862
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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 | A2009132
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License Number State | AR
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