Provider Demographics
NPI:1215693296
Name:ROUSE, KERRIE (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 QUAIL VALLEY DR # 327
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-8051
Mailing Address - Country:US
Mailing Address - Phone:512-355-1091
Mailing Address - Fax:
Practice Address - Street 1:601 QUAIL VALLEY DR # 327
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-8051
Practice Address - Country:US
Practice Address - Phone:512-355-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMC2976101YM0800X
TX87503101YP2500X
IDLPC-6741101YP2500X
TX204231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional