MEDICARE: LAURA ROUSE LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1932457090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ROUSE LCSW

Provider Business Mailing Address
First Line	:	525 E 15TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-5412
Country	:	US
Telephone Number	:	850-522-4485
Fax Number	:	850-522-4471

Provider Business Practice Location Address
First Line	:	429 S TYNDALL PKWY STE G
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-6746
Country	:	US
Telephone Number	:	850-960-2190
Fax Number	:

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

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	04/26/2018

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Directions to “ LAURA ROUSE LCSW” Practice Location

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