Provider Demographics
NPI:1659954550
Name:ROUSH, AVA LEE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:LEE
Last Name:ROUSH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:WV
Mailing Address - Zip Code:25265-0179
Mailing Address - Country:US
Mailing Address - Phone:304-882-8259
Mailing Address - Fax:
Practice Address - Street 1:310 4TH ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:WV
Practice Address - Zip Code:25265-1153
Practice Address - Country:US
Practice Address - Phone:304-882-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional