Healthcare Provider Details

I. General information

NPI: 1265386841
Provider Name (Legal Business Name): NATHAN DANIEL STOUT MS, CRC, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 CAROLINA ST
VALLEJO CA
94590-5424
US

IV. Provider business mailing address

402 CAROLINA ST
VALLEJO CA
94590-5424
US

V. Phone/Fax

Practice location:
  • Phone: 805-886-3741
  • Fax:
Mailing address:
  • Phone: 805-886-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC21427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: