Individual
KELSEY GRAY STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
914 E BROADWAY, LOUISVILLE, KY 40204-1037
(502) 587-8833
Mailing address
10401 LINN STATION RD STE 100, LOUISVILLE, KY 40223-3842
(502) 589-8600
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
267516
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100693460
—
KY
Enumeration date
04/28/2016
Last updated
12/30/2020
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