Provider Demographics
NPI:1972682490
Name:ROUSH, LOUISE BERDEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:BERDEAN
Last Name:ROUSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 MEAGHAN LEIGH DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1505
Mailing Address - Country:US
Mailing Address - Phone:405-348-9171
Mailing Address - Fax:
Practice Address - Street 1:2932 NW 122ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1957
Practice Address - Country:US
Practice Address - Phone:405-408-2816
Practice Address - Fax:405-436-0656
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical