MEDICARE: MRS. OPHELIA N ROGERS MED LPC

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	101YP2500X	Professional Counselor	4115	OK

General Provider Information

NPI Number	:	1194047381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OPHELIA N ROGERS MED LPC

Provider Business Mailing Address
First Line	:	17595 E 1240 RD
Second Line	:
City	:	ERICK
State	:	OK
Zip	:	73645-4522
Country	:	US
Telephone Number	:	580-414-0164
Fax Number	:	580-225-1130

Provider Business Practice Location Address
First Line	:	120 S MADISON AVE STE 24
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-5741
Country	:	US
Telephone Number	:	866-926-6552
Fax Number	:	580-225-1130

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

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	02/16/2010

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