Provider Demographics
NPI:1275674731
Name:ROUSSE, BRENDA KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:ROUSSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 MAIN ST
Mailing Address - Street 2:PO BOX 207
Mailing Address - City:OMER
Mailing Address - State:MI
Mailing Address - Zip Code:48749
Mailing Address - Country:US
Mailing Address - Phone:989-846-4573
Mailing Address - Fax:
Practice Address - Street 1:1000 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9421
Practice Address - Country:US
Practice Address - Phone:989-846-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010654231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical