Provider Demographics
NPI:1841643467
Name:AVISE-ROUSE, MEGAN (LMHC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:AVISE-ROUSE
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4103
Mailing Address - Country:US
Mailing Address - Phone:563-519-8226
Mailing Address - Fax:563-888-8657
Practice Address - Street 1:132 6TH AVE S # 4
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4103
Practice Address - Country:US
Practice Address - Phone:563-519-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA081853OtherLMHC LICENSURE
IA2714671Medicaid