Provider Demographics
NPI:1447951975
Name:ROGERS, MISTY CHE' (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:CHE'
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-0193
Mailing Address - Country:US
Mailing Address - Phone:903-376-3537
Mailing Address - Fax:
Practice Address - Street 1:213 N WALDRIP STREET
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140
Practice Address - Country:US
Practice Address - Phone:903-376-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57764104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker