Provider Demographics
NPI:1811299977
Name:PLOVER, MICHAEL (LCDC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:PLOVER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 HORIZON HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2258
Mailing Address - Country:US
Mailing Address - Phone:210-321-2700
Mailing Address - Fax:210-321-2705
Practice Address - Street 1:4455 HORIZON HL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2258
Practice Address - Country:US
Practice Address - Phone:210-321-2700
Practice Address - Fax:210-321-2705
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10140324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility