Provider Demographics
NPI:1841624186
Name:STOUT, JASON C (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:STOUT
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:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402-2500
Mailing Address - Country:US
Mailing Address - Phone:540-332-8095
Mailing Address - Fax:540-332-8202
Practice Address - Street 1:103 VALLEY CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24402-2500
Practice Address - Country:US
Practice Address - Phone:540-332-8095
Practice Address - Fax:540-332-8202
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical