Active NPI
Chava Shira Rousch-Carlisle, LCSW, APHSW-C
- Clinical Social Worker
- Pantego, TX
National Provider Identifier
1184378143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 63773
- Practice address
- 3210 W Park Row Dr
Pantego, TX 76013-3136 - Phone
- (817) 692-6917
- NPI assigned
- Feb 8, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Clinical Social Worker | 1041C0700X | 63773 | TX | Primary |
Addresses
Primary practice location
3210 W Park Row Dr
Pantego, TX 76013-3136
Mailing address
1418 W Pipeline Rd # 103
Hurst, TX 76053-4629
Phone (817) 692-6917
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63773 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705968000000",
"number": "1184378143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1418 W PIPELINE RD # 103",
"city": "HURST",
"state": "TX",
"postal_code": "760534629",
"telephone_number": "817-692-6917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3210 W PARK ROW DR",
"city": "PANTEGO",
"state": "TX",
"postal_code": "760133136",
"telephone_number": "817-692-6917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUSCH-CARLISLE",
"first_name": "CHAVA",
"middle_name": "SHIRA",
"credential": "LCSW, APHSW-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-02-08",
"last_updated": "2024-01-23",
"certification_date": "2024-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "63773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pantego, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.