Provider Demographics
NPI:1932351574
Name:STOUT, RONI MARIE (LLPC)
Entity Type:Individual
Prefix:
First Name:RONI
Middle Name:MARIE
Last Name:STOUT
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 CLARKSON CT
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-8496
Mailing Address - Country:US
Mailing Address - Phone:616-696-3935
Mailing Address - Fax:
Practice Address - Street 1:200 HOLTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3349
Practice Address - Country:US
Practice Address - Phone:231-744-5100
Practice Address - Fax:231-744-5110
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health