Provider Demographics
NPI:1679841639
Name:STOLL, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STOLL
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 1:2801 S VALLEY VIEW BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0116
Mailing Address - Country:US
Mailing Address - Phone:702-922-7015
Mailing Address - Fax:702-922-6600
Practice Address - Street 1:2801 S VALLEY VIEW BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0116
Practice Address - Country:US
Practice Address - Phone:702-922-7015
Practice Address - Fax:702-922-6600
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist