Provider Demographics
NPI:1437655040
Name:STOUT, BRAD (LCSW)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:STOUT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2199 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7416
Mailing Address - Country:US
Mailing Address - Phone:870-793-6774
Mailing Address - Fax:870-793-1997
Practice Address - Street 1:2199 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7416
Practice Address - Country:US
Practice Address - Phone:870-793-6774
Practice Address - Fax:870-793-1997
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR104100000X
AR8431-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker