MEDICARE: MICHELLE BABETTE KOUT LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMF79550	CA
2	101YM0800X	Mental Health Counselor	LMFT117026	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LMFT117026	OTHER	CA	BOARD OF BEHAVIORAL SCIENCES LICENSE

General Provider Information

NPI Number	:	1407307754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE BABETTE KOUT LMFT

Provider Business Mailing Address
First Line	:	2150 N CENTRE CITY PKWY STE M
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1347
Country	:	US
Telephone Number	:	760-642-1202
Fax Number	:	951-858-9215

Provider Business Practice Location Address
First Line	:	2150 N CENTRE CITY PKWY STE M
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1347
Country	:	US
Telephone Number	:	760-642-1202
Fax Number	:	951-858-9215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2016
Last Update Date	:	07/01/2023

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