Provider Demographics
NPI:1982564837
Name:DEBORA A. STOUT, PMHNP, LLC
Entity type:Organization
Organization Name:DEBORA A. STOUT, PMHNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DDEBORA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-338-6106
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-1310
Mailing Address - Country:US
Mailing Address - Phone:503-338-6106
Mailing Address - Fax:503-338-6126
Practice Address - Street 1:20 BASIN ST STE 106
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6237
Practice Address - Country:US
Practice Address - Phone:503-338-6106
Practice Address - Fax:503-338-6126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health