Provider Demographics
NPI:1720198773
Name:ROUGE, SHIRLEY JEAN (LMFT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:ROUGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 PRIMROSE DRIVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3520
Mailing Address - Country:US
Mailing Address - Phone:916-812-8235
Mailing Address - Fax:916-961-1107
Practice Address - Street 1:5330 PRIMROSE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3520
Practice Address - Country:US
Practice Address - Phone:916-812-8235
Practice Address - Fax:916-961-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist