Provider Demographics
NPI:1003385121
Name:RUIZ-STOUT, NIKKI ASHRAFIAN (BCBA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:ASHRAFIAN
Last Name:RUIZ-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 1:10329 FOREST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-1810
Mailing Address - Country:US
Mailing Address - Phone:949-300-9954
Mailing Address - Fax:
Practice Address - Street 1:120 PRECISION
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-5925
Practice Address - Country:US
Practice Address - Phone:949-300-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst