Provider Demographics
NPI:1962442004
Name:STOUGH, ROBERT LEE JR (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:STOUGH
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-0775
Mailing Address - Country:US
Mailing Address - Phone:509-527-2943
Mailing Address - Fax:
Practice Address - Street 1:409 E SUMACH ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1228
Practice Address - Country:US
Practice Address - Phone:509-527-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2938103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8855947Medicare ID - Type Unspecified