Provider Demographics
NPI:1477277929
Name:STOUT, KIMBERLY ALFORD
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALFORD
Last Name:STOUT
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 1:29752 MELINDA RD APT 513
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3454
Mailing Address - Country:US
Mailing Address - Phone:949-566-1250
Mailing Address - Fax:
Practice Address - Street 1:29752 MELINDA RD APT 513
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3454
Practice Address - Country:US
Practice Address - Phone:949-566-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling