Provider Demographics
NPI:1982034096
Name:PROUSE, FLORA ESTELLE
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:ESTELLE
Last Name:PROUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 RALSTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6010
Mailing Address - Country:US
Mailing Address - Phone:805-642-7033
Mailing Address - Fax:805-642-7201
Practice Address - Street 1:5225 TELEGRAPH RD FL 2
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4113
Practice Address - Country:US
Practice Address - Phone:805-642-7033
Practice Address - Fax:805-642-7201
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOther17