Individual
MR. DAVID FRANK STOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LCSW, MAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000615A
IN
1041C0700X
Clinical Social Worker
Primary
34002664A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000343506
ANTHEM BX/BS ID NUMBER
IN
01
—
083845-000
MAGELLAN ID NUMBER
IN
01
—
11347605
CAQH IDENTIFICATION NUMBE
IN
01
—
2200696
CIGNA/VALUEOPTIONS ID #
IN
01
—
6227695
UBH ID NUMBER
IN
01
—
STOUS-0001
COMPCARE ID NUMBER
IN
Enumeration date
07/31/2006
Last updated
04/05/2018
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