Provider Demographics
NPI:1730730334
Name:ROGOLS, JUSTIN TYLER (MBA, MA, LPCC-S)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:TYLER
Last Name:ROGOLS
Suffix:
Gender:M
Credentials:MBA, MA, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 ROBERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3646
Mailing Address - Country:US
Mailing Address - Phone:614-330-1387
Mailing Address - Fax:
Practice Address - Street 1:954 ROBERSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3646
Practice Address - Country:US
Practice Address - Phone:614-304-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMC1063101YM0800X
PAPC013553101YM0800X
OHE.2001785-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health