Healthcare Provider Details

I. General information

NPI: 1992965198
Provider Name (Legal Business Name): ELOUISE MALISA ROWDEN MENTAL HEALTH ASSOC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CRANES ROOST CT
ELIZABETHTOWN KY
42701-3650
US

IV. Provider business mailing address

316 INDIANA TRL
RADCLIFF KY
40160-1247
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-2605
  • Fax:
Mailing address:
  • Phone: 313-854-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094217
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: