Provider Demographics
NPI:1710386560
Name:STOVER, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E CHESTNUT AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-2200
Mailing Address - Country:US
Mailing Address - Phone:620-506-7379
Mailing Address - Fax:
Practice Address - Street 1:119 E CHESTNUT AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-2200
Practice Address - Country:US
Practice Address - Phone:620-506-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2017-09-15
Deactivation Date:2016-04-04
Deactivation Code:
Reactivation Date:2017-09-15
Provider Licenses
StateLicense IDTaxonomies
KS1257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist