Provider Demographics
NPI:1407862576
Name:STOUSE, DAVID FRANK (MA, LCSW, MAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FRANK
Last Name:STOUSE
Suffix:
Gender:M
Credentials:MA, LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 N MERIDIAN ST # 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1907 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46904-9010
Practice Address - Country:US
Practice Address - Phone:765-456-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000615A101YA0400X
IN34002664A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6227695OtherUBH ID NUMBER
INSTOUS-0001OtherCOMPCARE ID NUMBER
IN083845-000OtherMAGELLAN ID NUMBER
IN11347605OtherCAQH IDENTIFICATION NUMBE
IN2200696OtherCIGNA/VALUEOPTIONS ID #
IN000000343506OtherANTHEM BX/BS ID NUMBER