Individual
MRS. KELLY L ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBA, BCBA
Contact information
Practice address
7607 FERN AVE, SUITE 403, SHREVEPORT, LA 71105-5699
(318) 284-8481
Mailing address
425 ELMWOOD ST, SHREVEPORT, LA 71104-5009
(318) 218-3920
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L-434
LA
Other
Enumeration date
02/24/2020
Last updated
02/24/2020
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