Dr. Jeremy Wayne Stout, Ph.D.
Psychologist, Clinical in Richmond, VA. Individual provider (NPI-1).
NPI number1003370321
StatusActive
Last updated in NPPESApr 4, 2024
Details
- NPI
- 1003370321
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jeremy Wayne Stout
- Credential
- Ph.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 31, 2019
- Certification date
- Apr 4, 2024
- Last updated
- Apr 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | PY10800 | FL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1207 Broad Rock BlvdRichmond, VA 23249-1899
Phone 804-675-5000
Mailing address
269 Lookout Hill RdMilford, CT 06461-1899
Phone 808-375-4414
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