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NPI Code Detail

MEDICARE: LYNNEE CHANTEL ROGERS M.S., LCPC

MEDICARE: LYNNEE CHANTEL ROGERS M.S., LCPC
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
1101YM0800XMental Health CounselorLCPC-4591ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18P901OTHERIDBLUE CROSS

General Provider Information

NPI Number : 1972692804
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNNEE CHANTEL ROGERS M.S., LCPC
Provider Business Mailing Address
First Line : 849 E FAIRVIEW AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1806
Country : US
Telephone Number : 208-546-9395
Fax Number : 208-795-8611
Provider Business Practice Location Address
First Line : 849 E FAIRVIEW AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1806
Country : US
Telephone Number : 208-546-9395
Fax Number : 208-795-8611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 08/21/2024

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