Provider Demographics
NPI:1104945567
Name:STOUT, GRACE ANN (LCPC)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ANN
Last Name:STOUT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANN
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:2001 CORONA RD STE 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5924
Mailing Address - Country:US
Mailing Address - Phone:573-825-4056
Mailing Address - Fax:913-956-6686
Practice Address - Street 1:2001 CORONA RD STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5924
Practice Address - Country:US
Practice Address - Phone:573-825-4056
Practice Address - Fax:913-956-6686
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS217101YP2500X
MO2017044749101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional