Provider Demographics
NPI:1578603106
Name:STOUT, BETTY MILLARD (MA)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:MILLARD
Last Name:STOUT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SHOREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 6TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-3900
Practice Address - Country:US
Practice Address - Phone:360-479-1628
Practice Address - Fax:360-377-5088
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health