MEDICARE: DIAMOND RODGERS

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	101YM0800X	Mental Health Counselor		NV
2	106H00000X	Marriage & Family Therapist	3121	NV

General Provider Information

NPI Number	:	1639620412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIAMOND RODGERS

Provider Business Mailing Address
First Line	:	4360 TERRACE HILL RD APT 12-204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4585
Country	:	US
Telephone Number	:	702-236-4209
Fax Number	:

Provider Business Practice Location Address
First Line	:	5915 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2557
Country	:	US
Telephone Number	:	702-209-0370
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	12/23/2020

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Directions to “ DIAMOND RODGERS ” Practice Location

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