Individual
MRS. PHYLISS D. STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
300 GAULT AVE S, FORT PAYNE, AL 35967-1824
(256) 997-9356
(256) 997-9314
Mailing address
300 GAULT AVE S, FORT PAYNE, AL 35967-1824
(256) 997-9356
(256) 997-9314
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
1592C
AL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
1592C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51553422
—
AL
01
—
51553422STO
BCBS OF AL PROVIDER #
AL
Enumeration date
01/22/2007
Last updated
09/11/2025
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