Individual
THERESA LYNN ROUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS THERAPIST
Contact information
Practice address
515 W MAIN ST, LEESBURG, FL 34748-5148
(352) 842-9590
Mailing address
1498 WILLIAM ST APT 2, LEESBURG, FL 34748-3891
(480) 363-5176
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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