Healthcare Provider Details

I. General information

NPI: 1396551321
Provider Name (Legal Business Name): LINDSEY DEROUSSE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 TERRACE DR
ROSCOMMON MI
48653-2507
US

IV. Provider business mailing address

206 TERRACE DR
ROSCOMMON MI
48653-2507
US

V. Phone/Fax

Practice location:
  • Phone: 231-944-3112
  • Fax:
Mailing address:
  • Phone: 989-312-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LINDSEY DEROUSSE
Title or Position: PRESIDENT
Credential: LMSW
Phone: 231-944-3112