Provider Demographics
NPI:1811202484
Name:STOUT, CATHY L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:L
Last Name:STOUT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4632
Mailing Address - Country:US
Mailing Address - Phone:817-266-5472
Mailing Address - Fax:
Practice Address - Street 1:803 STADIUM DR STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6246
Practice Address - Country:US
Practice Address - Phone:817-459-2003
Practice Address - Fax:817-459-1898
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX396611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319625502OtherMEDICAID CSHCN
TX319625501Medicaid
89131QOtherBLUE CROSS BLUE SHIELD
TX286918YRK5OtherMEDICARE