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General NPI Number Information
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NPI Number | 1043826548
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Entity Type | Individual
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Provider Name | REGINA BUCCELLO-STOUT LPC
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Gender | Female
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Dates
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Enumeration Date | 09/20/2020
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Last Update Date | 09/20/2020
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Provider Practice Location Address
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Address Line | 5909 WEST LOOP S
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City | BELLAIRE
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State | TX
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Zip | 77401-2402
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Country | US
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Telephone | 713-591-3612
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Fax |
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Provider Business Mailing Address
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Address Line | 10127 DEERPARK DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-7341
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Country | US
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Telephone | 832-978-5199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 75214
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License Number State | TX
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