Provider Demographics
NPI:1407549413
Name:STOUTMIRE, ANGELIKA
Entity Type:Individual
Prefix:
First Name:ANGELIKA
Middle Name:
Last Name:STOUTMIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 STRIEBEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2064
Mailing Address - Country:US
Mailing Address - Phone:614-893-9343
Mailing Address - Fax:
Practice Address - Street 1:1235 STRIEBEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2064
Practice Address - Country:US
Practice Address - Phone:614-893-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service