Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 2551489 | AR |
N | 101YM0800X | Mental Health Counselor | 2551489 | AR |
N | 101YP1600X | Pastoral Counselor | 2551489 | AR |
N | 101YP2500X | Professional Counselor | 2551489 | AR |
N | 106S00000X | Behavior Technician | ST-390200000X |
NPI | 1184236408 |
---|---|
Provider Name | Heather Rogero |
First Address | Mountain Home, AR 72653-8126 |
Second Address | Mountain Home, AR 72653-8126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2020 |
Last Update Date | 18/08/2020 |