Individual
KELLY LOUISE ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4225 W GLENDALE AVE STE E104, PHOENIX, AZ 85051-8153
(336) 459-5623
Mailing address
4225 W GLENDALE AVE, PHOENIX, AZ 85051-8194
(336) 459-5623
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
OTC13869
AZ
Other
Enumeration date
09/27/2025
Last updated
10/01/2025
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