Active NPI
Theresa Lynn Roush, MS THERAPIST
- Clinical Child & Adolescent Psychologist
- Leesburg, FL
National Provider Identifier
1972359420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- Practice address
- 515 W Main St
Leesburg, FL 34748-5148 - Phone
- (352) 842-9590
- NPI assigned
- Apr 25, 2024
- Last updated
- Apr 25, 2024
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | NU | ||
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | NU | ||
| Cognitive & Behavioral Psychologist | 103TB0200X | NU | ||
| Counseling Psychologist | 103TC1900X | NU | ||
| Clinical Child & Adolescent Psychologist | 103TC2200X | NU | Primary |
Addresses
Primary practice location
515 W Main St
Leesburg, FL 34748-5148
Mailing address
1498 William St Apt 2
Leesburg, FL 34748-3891
Phone (480) 363-5176
Other practice location 1
110 S Apopka Ave
Inverness, FL 34452-4837
Phone (352) 560-7027
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714003200000",
"number": "1972359420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1498 WILLIAM ST APT 2",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347483891",
"telephone_number": "480-363-5176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 W MAIN ST",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347485148",
"telephone_number": "352-842-9590"
}
],
"practiceLocations": [
{
"address_1": "110 S Apopka Ave",
"address_purpose": "LOCATION",
"city": "Inverness",
"state": "FL",
"postal_code": "344524837",
"country_code": "US",
"telephone_number": "352-560-7027",
"fax_number": "352-877-4162",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROUSH",
"first_name": "THERESA",
"middle_name": "LYNN",
"credential": "MS THERAPIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-25",
"last_updated": "2024-04-25",
"certification_date": "2024-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.