Provider Demographics
NPI:1407307754
Name:KOUT, MICHELLE BABETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BABETTE
Last Name:KOUT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 N CENTRE CITY PKWY STE M
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1347
Mailing Address - Country:US
Mailing Address - Phone:760-642-1202
Mailing Address - Fax:951-858-9215
Practice Address - Street 1:2150 N CENTRE CITY PKWY STE M
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1347
Practice Address - Country:US
Practice Address - Phone:760-642-1202
Practice Address - Fax:951-858-9215
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF79550101YM0800X
CALMFT117026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT117026OtherBOARD OF BEHAVIORAL SCIENCES LICENSE