Provider Demographics
NPI:1871196667
Name:STOUGH, CHRISTOPHER LEE (LSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:STOUGH
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 JACKS RUN RD
Mailing Address - Street 2:PARKSIDE BUILDING ONE, SUITE 5
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2549
Mailing Address - Country:US
Mailing Address - Phone:412-385-7139
Mailing Address - Fax:412-896-5451
Practice Address - Street 1:3025 JACKS RUN ROAD
Practice Address - Street 2:PARKSIDE BUILDING ONE SUITE 5
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-1513
Practice Address - Country:US
Practice Address - Phone:412-385-7139
Practice Address - Fax:412-896-5451
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker