Individual
BROCK STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1454 N COUNTY ROAD 2050 E, CARTHAGE, IL 62321-3551
(217) 357-6888
Mailing address
1830 PARLEY ST, NAUVOO, IL 62354-1352
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
122471
IA
Other
Enumeration date
01/30/2024
Last updated
08/10/2024
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