MEDICARE: MS. LISA MACDOWELL ROGERS LCSW

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	1041C0700X	Clinical Social Worker	19685	TX

General Provider Information

NPI Number	:	1972736858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MACDOWELL ROGERS LCSW

Provider Business Mailing Address
First Line	:	23099 COUNTY ROAD 3197 S
Second Line	:
City	:	MT ENTERPRISE
State	:	TX
Zip	:	75681-6432
Country	:	US
Telephone Number	:	903-263-9001
Fax Number	:

Provider Business Practice Location Address
First Line	:	23099 COUNTY ROAD 3197 S
Second Line	:
City	:	MT ENTERPRISE
State	:	TX
Zip	:	75681-6432
Country	:	US
Telephone Number	:	903-263-9001
Fax Number	:

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

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	08/26/2009

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