Provider Demographics
NPI:1134337678
Name:ROGERS, GORDON WAYNE (LCPC)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:WAYNE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 CAPRI LANE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207
Mailing Address - Country:US
Mailing Address - Phone:316-688-0979
Mailing Address - Fax:316-265-0427
Practice Address - Street 1:300 W DOUGLAS AVE STE 930
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2912
Practice Address - Country:US
Practice Address - Phone:316-265-9922
Practice Address - Fax:316-265-9427
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health