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General NPI Number Information
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NPI Number | 1871832519
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Entity Type | Organization
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Legal Business Name | ROUSH COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 123 E TONHAWA ST SUITE 100
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City | NORMAN
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State | OK
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Zip | 73069-7209
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Country | US
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Telephone | 405-306-1163
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Fax | 405-794-7506
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Provider Business Mailing Address
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Address Line | 123 E TONHAWA ST SUITE 100
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City | NORMAN
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State | OK
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Zip | 73069-7209
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Country | US
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Telephone | 405-306-1163
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Fax | 405-794-7506
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Authorized Official
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Title or Position | OWNER
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Name | KIMBRA L ROUSH
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Credential | MED, LPC
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Telephone | 405-306-1163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4179
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License Number State | OK
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