| NPI | 1104945567 |
|---|---|
| Former Name | GRACE ANN STOUT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MO 2017044749) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KS 217) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2022-05-18 |