MEDICARE: MR. MARK ROGERS LPC,LBSW

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	6401000566	MI
2	1041C0700X	Clinical Social Worker	6802062229	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770911257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ROGERS LPC,LBSW

Provider Business Mailing Address
First Line	:	7027 MELDRUM
Second Line	:
City	:	FAIR HAVEN
State	:	MI
Zip	:	48023
Country	:	US
Telephone Number	:	586-725-0560
Fax Number	:

Provider Business Practice Location Address
First Line	:	7027 MELDRUM RD
Second Line	:
City	:	IRA
State	:	MI
Zip	:	48023-2427
Country	:	US
Telephone Number	:	586-725-0560
Fax Number	:

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

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	10/22/2013

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