Basic Information
| Provider Information | |||||||||
| NPI: | 1598709172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2535 E MOUNT HOPE AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489101913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173722377 | ||||||||
| FaxNumber: | 5173722542 | ||||||||
| Practice Location | |||||||||
| Address1: | 2535 E MOUNT HOPE AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489101913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173722377 | ||||||||
| FaxNumber: | 5173722542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 12/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/27/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401001324 | MI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC0700X | 6301008175 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 61-45419 | 01 | MI | UNITED BEHAVIORAL HEALTH | OTHER | 038457 | 01 | MI | BLUE CARE NETWORK | OTHER | 680C312960 | 01 | MI | BCBS/MICHIGAN | OTHER |