Provider Demographics
NPI:1831836089
Name:ROUSAN, MONA JAMAL ALI
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:JAMAL ALI
Last Name:ROUSAN
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 1:1325 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3786
Mailing Address - Country:US
Mailing Address - Phone:615-558-8294
Mailing Address - Fax:
Practice Address - Street 1:1325 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3786
Practice Address - Country:US
Practice Address - Phone:615-558-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician