Provider Demographics
NPI:1861914780
Name:RODGERS, TROYA VANIVER
Entity type:Individual
Prefix:
First Name:TROYA
Middle Name:VANIVER
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DOMINION PARK DR APT 1127
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-6765
Mailing Address - Country:US
Mailing Address - Phone:832-594-7333
Mailing Address - Fax:
Practice Address - Street 1:200 DOMINION PARK DRIVE
Practice Address - Street 2:1127
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:832-594-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care