Provider Demographics
NPI:1285411942
Name:SHOUSE, HAROLD (CPSS)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:SHOUSE
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3317
Mailing Address - Country:US
Mailing Address - Phone:859-489-4719
Mailing Address - Fax:
Practice Address - Street 1:1629 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3317
Practice Address - Country:US
Practice Address - Phone:859-489-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist