Provider Demographics
NPI:1386380855
Name:STOUT, MCCARTNIE
Entity type:Individual
Prefix:
First Name:MCCARTNIE
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 W 4000 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4752
Mailing Address - Country:US
Mailing Address - Phone:801-376-4336
Mailing Address - Fax:
Practice Address - Street 1:556 E 300 S
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3844
Practice Address - Country:US
Practice Address - Phone:801-980-2566
Practice Address - Fax:801-610-2017
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical