Provider Demographics
NPI:1477740256
Name:STOVALL, LEIGHLAND SHAWN
Entity Type:Individual
Prefix:
First Name:LEIGHLAND
Middle Name:SHAWN
Last Name:STOVALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4066
Mailing Address - Country:US
Mailing Address - Phone:469-762-5083
Mailing Address - Fax:469-762-5083
Practice Address - Street 1:2106 THISTLE LN
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4066
Practice Address - Country:US
Practice Address - Phone:469-762-5083
Practice Address - Fax:469-762-5083
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19837101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional