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General NPI Number Information
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NPI Number | 1063619096
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Entity Type | Individual
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Provider Name | DELAYNA JEAN STOUT LPC
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Gender | Female
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 8541 S REDWOOD RD STE C
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City | WEST JORDAN
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State | UT
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Zip | 84088-9327
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Country | US
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Telephone | 801-878-4220
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Fax | 801-878-9846
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Provider Business Mailing Address
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Address Line | 215 HILL AVE APT 3
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-1555
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Country | US
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Telephone | 801-864-4813
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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 | 8363706004
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License Number State | UT
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