Provider Demographics
NPI:1801693387
Name:STOUT, NIKOLAS GILBERT
Entity type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:GILBERT
Last Name:STOUT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12313 BEARSDALE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6065
Mailing Address - Country:US
Mailing Address - Phone:317-919-5808
Mailing Address - Fax:
Practice Address - Street 1:9905 FALL CREEK ROAD, INDIANAPOLIS, IN 46256
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4623
Practice Address - Country:US
Practice Address - Phone:317-813-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician