Individual
TAREA STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
604 HIGHWAY 80 W STE R, CLINTON, MS 39056-4108
(601) 664-8683
Mailing address
213 PAXTON CV, MADISON, MS 39110-8900
(601) 664-8683
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
493
MS
Other
Enumeration date
09/26/2018
Last updated
06/13/2023
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