Provider Demographics
NPI:1780130245
Name:ROUSE, RACHEL DIANE (MS, LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANE
Last Name:ROUSE
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 1:418 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5439
Mailing Address - Country:US
Mailing Address - Phone:806-438-8919
Mailing Address - Fax:
Practice Address - Street 1:1903 W PEARL STREET
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048
Practice Address - Country:US
Practice Address - Phone:806-438-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72713101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor