Provider Demographics
NPI:1801330626
Name:STOVALL, VIVIAN LETICIA (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:LETICIA
Last Name:STOVALL
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 FARM RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8171
Mailing Address - Country:US
Mailing Address - Phone:702-546-9600
Mailing Address - Fax:702-829-8065
Practice Address - Street 1:1820 E WARM SPRINGS RD STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4680
Practice Address - Country:US
Practice Address - Phone:702-546-9600
Practice Address - Fax:702-829-8065
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016144103TC0700X
NVPY0844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical