Healthcare Provider Details

I. General information

NPI: 1871832519
Provider Name (Legal Business Name): ROUSH COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E TONHAWA ST SUITE 100
NORMAN OK
73069-7209
US

IV. Provider business mailing address

123 E TONHAWA ST SUITE 100
NORMAN OK
73069-7209
US

V. Phone/Fax

Practice location:
  • Phone: 405-306-1163
  • Fax: 405-794-7506
Mailing address:
  • Phone: 405-306-1163
  • Fax: 405-794-7506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4179
License Number StateOK

VIII. Authorized Official

Name: KIMBRA L ROUSH
Title or Position: OWNER
Credential: MED, LPC
Phone: 405-306-1163