Individual
ELLIS STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1606 E DOWNING ST, TAHLEQUAH, OK 74464-2573
(918) 453-1217
(918) 453-0971
Mailing address
1606 E DOWNING ST, TAHLEQUAH, OK 74464-2573
(918) 453-1217
(918) 453-0971
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3039
OK
Other
Enumeration date
09/27/2012
Last updated
09/27/2012
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