Provider Demographics
NPI:1487223152
Name:STOVALL, DARAN SCOTT
Entity Type:Individual
Prefix:
First Name:DARAN
Middle Name:SCOTT
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 1:1704 W INDUSTRIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-2497
Mailing Address - Country:US
Mailing Address - Phone:479-439-6906
Mailing Address - Fax:
Practice Address - Street 1:1704 W INDUSTRIAL DR STE C
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2497
Practice Address - Country:US
Practice Address - Phone:479-439-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician