Provider Demographics
NPI:1720734338
Name:STOUT ADVANCEMENT ABA SERVICES LLC
Entity Type:Organization
Organization Name:STOUT ADVANCEMENT ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:256-343-2010
Mailing Address - Street 1:3171 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2707
Mailing Address - Country:US
Mailing Address - Phone:256-343-2010
Mailing Address - Fax:
Practice Address - Street 1:3171 CLEMSON RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2707
Practice Address - Country:US
Practice Address - Phone:256-343-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-2694OtherBEHAVIOR ANALYST CERTIFICATION BOARD