Provider Demographics
NPI:1205387834
Name:ROUSE, SAMANTHA M (LPCC-S)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:ROUSE
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-8898
Mailing Address - Country:US
Mailing Address - Phone:270-401-1157
Mailing Address - Fax:
Practice Address - Street 1:2680 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-8898
Practice Address - Country:US
Practice Address - Phone:270-401-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY247285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health