Provider Demographics
NPI:1861731739
Name:STOUT, ELIZABETH BROOKE (BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BROOKE
Last Name:STOUT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 26TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3014
Mailing Address - Country:US
Mailing Address - Phone:360-556-9777
Mailing Address - Fax:
Practice Address - Street 1:1570 WILMINGTON DRIVE
Practice Address - Street 2:STE 220
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327
Practice Address - Country:US
Practice Address - Phone:206-453-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst