Active NPI
Matrice Sharnan Rouse
- Mental Health Counselor
- Blythewood, SC
National Provider Identifier
1679690572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1507
- Practice address
- 200 Claude Bundrick Rd
Blythewood, SC 29016-9420 - Phone
- (803) 754-5478
- NPI assigned
- Mar 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1507 | SC | Primary |
Addresses
Primary practice location
200 Claude Bundrick Rd
Blythewood, SC 29016-9420
Mailing address
111 Elders Pond Cir Apt 13C
Columbia, SC 29229-8164
Phone (803) 513-0821
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 |
|---|---|---|---|
| 1507 | SC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679690572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 ELDERS POND CIR APT 13C",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292298164",
"telephone_number": "803-513-0821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 CLAUDE BUNDRICK RD",
"city": "BLYTHEWOOD",
"state": "SC",
"postal_code": "290169420",
"telephone_number": "803-754-5478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUSE",
"first_name": "MATRICE",
"middle_name": "SHARNAN",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "SC",
"license": "1507",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blythewood, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.