Provider Demographics
NPI:1013345495
Name:ROUSE, THELMA (PHD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:THELMA
Other - Middle Name:
Other - Last Name:ROUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC, NCC, LMFT
Mailing Address - Street 1:PO BOX 3291
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-0291
Mailing Address - Country:US
Mailing Address - Phone:469-584-9675
Mailing Address - Fax:
Practice Address - Street 1:6406 HIGHWAY 78 STE 108
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-3276
Practice Address - Country:US
Practice Address - Phone:469-584-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71483101YP2500X
TX202954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional