MEDICARE: SHAWN DIMITRI ROUSE CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor		OH
2	101YM0800X	Mental Health Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA186118	OH

General Provider Information

NPI Number	:	1033742903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN DIMITRI ROUSE CDCA

Provider Business Mailing Address
First Line	:	5665 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1821
Country	:	US
Telephone Number	:	203-407-9825
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 MUDDY CREEK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2057
Country	:	US
Telephone Number	:	513-347-0375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	07/31/2024

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Directions to “ SHAWN DIMITRI ROUSE CDCA” Practice Location

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