Individual provider Active NPI

Tiffany Kaye Stout

  • Mental Health Counselor
  • Spring, TX
National Provider Identifier
1346828555
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
85713 Issued in TX
Practice address
2219 Sawdust Rd Ste 105
Spring, TX 77380-2576
Phone
(832) 241-8003
NPI assigned
Mar 30, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 85713 TX Primary

Addresses

Primary practice location

2219 Sawdust Rd Ste 105
Spring, TX 77380-2576

Mailing address

7711 Leafbrook LN
Spring, TX 77379-4052
Phone (832) 792-5367

Other practice location 1

123 Blue Heron Dr
Montgomery, TX 77316-3192
Phone (936) 439-8053

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20240621001770 TX Practitioner - Mental Health Counselor 9335682053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lake Conroe Counseling Center PLLCGroup PAC ID 4789026543, 4 clinicians

Practice addresses (Care Compare)

123 Blue Heron Dr
Suite 104
Montgomery, TX 77316-3192
Phone (936) 449-8053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
85713TXMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Conroe Counseling Center, PLLC CurrentSince Jun 5, 2024 Accepting new patients
Sandstone Chiropratic, P.a. PastSince Jun 5, 2024 Accepting new patients

Locations

123 Blue Heron Dr
Ste 102
Montgomery, TX 77316
Phone (936) 449-8053

123 Blue Heron Dr
Ste 104
Montgomery, TX 77316
Phone (936) 449-8053

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": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1346828555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7711 LEAFBROOK LN",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773794052",
            "telephone_number": "832-792-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 SAWDUST RD STE 105",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773802576",
            "telephone_number": "832-241-8003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "123 Blue Heron Dr",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "TX",
            "postal_code": "773163192",
            "country_code": "US",
            "telephone_number": "936-439-8053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOUT",
        "first_name": "TIFFANY",
        "middle_name": "KAYE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "85713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring, TX

Sources for this page

Verify at the official NPI Registry.