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General NPI Number Information
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NPI Number | 1841493590
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Entity Type | Individual
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Provider Name | REGINA LYNN RODGERS LBP
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Gender | Female
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1001 W MAIN ST
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City | DURANT
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State | OK
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Zip | 74701-5038
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Country | US
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Telephone | 580-924-7330
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Fax | 580-924-2739
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Provider Business Mailing Address
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Address Line | 2415 MONTE CRISTO DR
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City | SHERMAN
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State | TX
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Zip | 75092-2325
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Country | US
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Telephone | 580-924-7330
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Fax | 580-924-2739
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0017
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License Number State | OK
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