Active NPI
Avon Lynn Rousan, LPC
- Professional Counselor
- Lake St Louis, MO
National Provider Identifier
1992820104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 002534
- Practice address
- 1306 Edgewater Pointe
Lake St Louis, MO 63367-2908 - Phone
- (636) 561-5511
- Fax
- (636) 561-5537
- NPI assigned
- Mar 20, 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 002534 | MO | Primary |
Addresses
Primary practice location
1306 Edgewater Pointe
Lake St Louis, MO 63367-2908
Mailing address
1306 Edgewater Pointe
Lake St Louis, MO 63367-2908
Phone (636) 561-5511
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 |
|---|---|---|---|
| 002534 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992820104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1306 EDGEWATER POINTE",
"city": "LAKE ST LOUIS",
"state": "MO",
"postal_code": "633672908",
"telephone_number": "636-561-5511",
"fax_number": "636-561-5537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1306 EDGEWATER POINTE",
"city": "LAKE ST LOUIS",
"state": "MO",
"postal_code": "633672908",
"telephone_number": "636-561-5511",
"fax_number": "636-561-5537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUSAN",
"first_name": "AVON",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "002534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake St Louis, MO
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.