Provider Demographics
NPI:1689490534
Name:ROUSE, TORRY (CDCA, CPRS)
Entity type:Individual
Prefix:
First Name:TORRY
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:CDCA, CPRS
Other - Prefix:MS
Other - First Name:TORRY
Other - Middle Name:
Other - Last Name:ROUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA, CPRS
Mailing Address - Street 1:7830 DUEBER AVE SW
Mailing Address - Street 2:
Mailing Address - City:EAST SPARTA
Mailing Address - State:OH
Mailing Address - Zip Code:44626-9725
Mailing Address - Country:US
Mailing Address - Phone:330-685-2312
Mailing Address - Fax:
Practice Address - Street 1:1737 GEORGETOWN RD.
Practice Address - Street 2:SUITE H/I
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5013
Practice Address - Country:US
Practice Address - Phone:330-355-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA186901101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)