Basic Information
| Provider Information | |||||||||
| NPI: | 1194473934 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROUSE CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 ELMWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711045009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182183920 | ||||||||
| FaxNumber: | 3186662361 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 ELMWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711045009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182183920 | ||||||||
| FaxNumber: | 3186662361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2022 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROUSE | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3182183920 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA, LBA | ||||||||
| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.