Provider Demographics
NPI:1942564182
Name:STOVER, ANDREW (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STOVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S 52ND ST
Mailing Address - Street 2:200
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8637
Mailing Address - Country:US
Mailing Address - Phone:479-254-1100
Mailing Address - Fax:479-254-2997
Practice Address - Street 1:900 S 52ND ST
Practice Address - Street 2:200
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8637
Practice Address - Country:US
Practice Address - Phone:479-254-1100
Practice Address - Fax:479-254-2997
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6588-M104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR197277744Medicaid