Provider Demographics
NPI:1871769133
Name:ROGERS, CHRISTIE THERESE (LPC LISAC)
Entity type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:THERESE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8070 N WILDOMAR DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1180
Mailing Address - Country:US
Mailing Address - Phone:520-370-5926
Mailing Address - Fax:
Practice Address - Street 1:3315 N TOLTEC RD
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85231-9680
Practice Address - Country:US
Practice Address - Phone:520-466-2353
Practice Address - Fax:520-466-2399
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ185182Medicaid