Provider Demographics
NPI:1467410951
Name:OUTCALT, ROGER L (MSW, ACSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:L
Last Name:OUTCALT
Suffix:
Gender:M
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10565 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-3182
Mailing Address - Country:US
Mailing Address - Phone:317-852-5065
Mailing Address - Fax:317-852-5096
Practice Address - Street 1:4715 W 116TH ST
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9311
Practice Address - Country:US
Practice Address - Phone:317-873-8140
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical