Healthcare Provider Details

I. General information

NPI: 1982950697
Provider Name (Legal Business Name): KEILA Z STOUT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N IRWIN ST STE 210
HANFORD CA
93230-4579
US

IV. Provider business mailing address

101 N IRWIN ST STE 210
HANFORD CA
93230-4579
US

V. Phone/Fax

Practice location:
  • Phone: 559-574-1504
  • Fax: 559-584-1771
Mailing address:
  • Phone: 559-574-1504
  • Fax: 559-584-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT86610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: