Provider Demographics
NPI:1043826548
Name:BUCCELLO-STOUT, REGINA (LPC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BUCCELLO-STOUT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10127 DEERPARK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7341
Mailing Address - Country:US
Mailing Address - Phone:832-978-5199
Mailing Address - Fax:
Practice Address - Street 1:5909 WEST LOOP S
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2402
Practice Address - Country:US
Practice Address - Phone:713-591-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional