MEDICARE: ANDREW HARRISON ROGERS M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1104437524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW HARRISON ROGERS M.A.

Provider Business Mailing Address
First Line	:	1147 1/2 S SHERBOURNE DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2303
Country	:	US
Telephone Number	:	818-370-5717
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 WILSHIRE BLVD STE 870
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5531
Country	:	US
Telephone Number	:	800-624-1475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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