Individual provider Active NPI

Tarea Stout, LPC

  • Professional Counselor
  • Clinton, MS
National Provider Identifier
1063997955
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
493 Issued in MS
Practice address
604 Highway 80 W Ste R
Clinton, MS 39056-4108
Phone
(601) 664-8683
NPI assigned
Sep 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 493 MS Primary

Addresses

Primary practice location

604 Highway 80 W Ste R
Clinton, MS 39056-4108

Mailing address

213 Paxton CV
Madison, MS 39110-8900
Phone (601) 664-8683

Other practice location 1

7570 Old Canton Rd Ste 102
Madison, MS 39110-6100
Phone (601) 809-5324

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240930000204 MS Practitioner - Mental Health Counselor 2961933171 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Coaching ClinicGroup PAC ID 9638618416, 4 clinicians

Practice addresses (Care Compare)

105 Executive Dr
Suite B
Madison, MS 39110-8496
Phone (601) 910-9758

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
493MSMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Family Coaching Clinic CurrentSince Sep 1, 2024 Accepting new patients
Child Development and Support Services CurrentSince Jun 23, 2025 Accepting new patients

Locations

105 Executive Dr
Ste B
Madison, MS 39110
Phone (601) 506-2292

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1063997955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 PAXTON CV",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391108900",
            "telephone_number": "601-664-8683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 HIGHWAY 80 W STE R",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390564108",
            "telephone_number": "601-664-8683"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7570 Old Canton Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391106100",
            "country_code": "US",
            "telephone_number": "601-809-5324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOUT",
        "first_name": "TAREA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-26",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MS

Sources for this page

Verify at the official NPI Registry.