Provider Demographics
NPI:1184799983
Name:STOUT, RICHARD HARLAND (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HARLAND
Last Name:STOUT
Suffix:
Gender:M
Credentials:MS, LMHC
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 953443
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-3443
Mailing Address - Country:US
Mailing Address - Phone:407-323-0027
Mailing Address - Fax:407-322-0448
Practice Address - Street 1:3272 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 1820
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-323-0027
Practice Address - Fax:407-322-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health