Provider Demographics
NPI:1043084833
Name:ROGLAND, EDWARD ALAN (LPC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALAN
Last Name:ROGLAND
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 MOCCASIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3418
Mailing Address - Country:US
Mailing Address - Phone:307-631-7900
Mailing Address - Fax:
Practice Address - Street 1:6228 MOCCASIN AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3418
Practice Address - Country:US
Practice Address - Phone:307-631-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013951101YP2500X
WYLPC-2149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional