Individual
DOMINIQUE MICHELLEE ROUGEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA
Contact information
Practice address
1905 TYBEE LN, LAKE CHARLES, LA 70605-4172
(337) 240-8162
Mailing address
18840 NW ROCK CREEK CIR APT 285, PORTLAND, OR 97229-7204
(337) 292-5906
(618) 418-4422
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
L-344
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3647681
—
LA
Enumeration date
01/16/2019
Last updated
05/08/2025
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