Provider Demographics
NPI:1336714161
Name:STOCK, DANIEL GARY
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GARY
Last Name:STOCK
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 1:4381 CHESSMAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4639
Mailing Address - Country:US
Mailing Address - Phone:702-205-2511
Mailing Address - Fax:
Practice Address - Street 1:8390 W WINDMILL LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4420
Practice Address - Country:US
Practice Address - Phone:702-485-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst