Individual
ALYSSA ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
465 WINN WAY STE 140, DECATUR, GA 30030-1722
(470) 403-2830
(470) 427-5560
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(866) 610-0580
(407) 588-6294
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YLD84037016
EMPIRE BLUECROSS BLUESHIELD
NY
Enumeration date
06/20/2012
Last updated
05/19/2021
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