Healthcare Provider Details

I. General information

NPI: 1023619160
Provider Name (Legal Business Name): BROOKE ROUSH LICDC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 LAFAYETTE ST STE E
LONDON OH
43140-8567
US

IV. Provider business mailing address

28 WESTMOOR DR
LONDON OH
43140-1058
US

V. Phone/Fax

Practice location:
  • Phone: 614-792-6242
  • Fax: 614-792-6240
Mailing address:
  • Phone: 614-674-7395
  • Fax: 614-792-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162963
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2310067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: