Provider Demographics
NPI:1851021174
Name:ROUSE, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ROUSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13090 SIERRA PADRE WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7209
Mailing Address - Country:US
Mailing Address - Phone:760-508-2943
Mailing Address - Fax:
Practice Address - Street 1:749 GATEWAY STE F-703
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1196
Practice Address - Country:US
Practice Address - Phone:325-530-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician