Provider Demographics
NPI:1972865228
Name:STOVER, MARYANN
Entity Type:Individual
Prefix:
First Name:MARYANN
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 1:3450 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8222
Mailing Address - Country:US
Mailing Address - Phone:702-631-0230
Mailing Address - Fax:702-631-0809
Practice Address - Street 1:3450 W CHEYENNE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8222
Practice Address - Country:US
Practice Address - Phone:702-631-0230
Practice Address - Fax:702-631-0809
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst