Provider Demographics
NPI:1881841088
Name:STOUT, LISA D (MFTI)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:STOUT
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2802
Mailing Address - Country:US
Mailing Address - Phone:530-247-3342
Mailing Address - Fax:530-247-3383
Practice Address - Street 1:2400 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2802
Practice Address - Country:US
Practice Address - Phone:530-247-3342
Practice Address - Fax:530-247-3383
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist