| Doctor Name: | MRS. PHYLISS D. STOUT |
| NPI Number: | 1073667622 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 1592C |
| Business Practice Address: | 300 Gault Ave S Fort Payne, AL - 359671824 |
| Business Phone Number: | 2569979356 |
| Business Fax Number: | 2569979314 |
| Mailing Address: | 300 Gault Ave S, FORT PAYNE |
| State: | AL |
| Postal Code: | 359671824 |
| Phone Number: | 2569979356 |
| Fax Number: | 2569979314 |
| NPI Enumeration Date: | 01/22/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0850X |
| License Number: | 1592C |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | AL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Mental Health |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |