Provider Demographics
NPI:1134643273
Name:JROUSSO COUNSELING, LLC
Entity Type:Organization
Organization Name:JROUSSO COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JEANINE
Authorized Official - Last Name:ROUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-677-5300
Mailing Address - Street 1:1131 MACK BAYOU RD STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-3113
Mailing Address - Country:US
Mailing Address - Phone:850-677-5300
Mailing Address - Fax:
Practice Address - Street 1:1131 MACK BAYOU RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3113
Practice Address - Country:US
Practice Address - Phone:850-677-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15252261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health