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Individual

MRS. BETHANY S STOUT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LADC

Contact information

Practice address
1095 NICKERSON ST, WAYNOKA, OK 73860-1252
(580) 824-0674
Mailing address
409 OKLAHOMA BLVD, ALVA, OK 73717-2711
(580) 327-1825

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
764
OK

Other

Enumeration date
04/11/2007
Last updated
07/12/2010
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