MEDICARE: MRS. JENINE MARIE ROUSE LMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1344	NE

General Provider Information

NPI Number	:	1568649432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENINE MARIE ROUSE LMHP

Provider Business Mailing Address
First Line	:	8650 PIONEERS BLVD
Second Line	:	SAMARITAN COUNSELING CENTER
City	:	LINCOLN
State	:	NE
Zip	:	68520
Country	:	US
Telephone Number	:	402-483-5117
Fax Number	:	402-483-5154

Provider Business Practice Location Address
First Line	:	8650 PIONEERS BLVD
Second Line	:	SAMARITAN COUNSELING CENTER
City	:	LINCOLN
State	:	NE
Zip	:	68520
Country	:	US
Telephone Number	:	402-483-5117
Fax Number	:	402-483-5154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/23/2008

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