Provider Demographics
NPI:1457431967
Name:MOUTON, STEPHEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:MOUTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N RAYMOND AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3930
Mailing Address - Country:US
Mailing Address - Phone:800-585-6683
Mailing Address - Fax:
Practice Address - Street 1:30 N RAYMOND AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3930
Practice Address - Country:US
Practice Address - Phone:800-585-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical