Individual provider · NPI-1

Timothy A A Rogers

Counselor, Mental Health · Portland, OR

NPI number1053063487
StatusActive
Last updated in NPPESJan 26, 2022

Details

NPI
1053063487
Entity type
Individual (NPI-1)
Name
Timothy A A Rogers
Sex
Male
Sole proprietor
Yes
Enumeration date
Jan 26, 2022
Certification date
Jan 26, 2022
Last updated
Jan 26, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YM0800X Counselor, Mental Healthlmsw-18262AZYes

Practice location

1505 Ne 122nd Ave
Portland, OR 97230-1911

Phone 503-688-5361

Mailing address

1505 Ne 122nd Ave
Portland, OR 97230-1911

Phone 503-688-5361

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