Healthcare Provider Details

I. General information

NPI: 1831207653
Provider Name (Legal Business Name): PATRICIA STOUT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71667 LEVESON ST
ABITA SPRINGS LA
70420-3635
US

IV. Provider business mailing address

PO BOX 942
MANDEVILLE LA
70470-0942
US

V. Phone/Fax

Practice location:
  • Phone: 985-264-8089
  • Fax:
Mailing address:
  • Phone: 985-264-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW3035
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: