Healthcare Provider Details

I. General information

NPI: 1669183521
Provider Name (Legal Business Name): JULIE L STOVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2083 SANDY COVE DR
KALAMAZOO MI
49048-8201
US

IV. Provider business mailing address

2083 SANDY COVE DR
KALAMAZOO MI
49048-8201
US

V. Phone/Fax

Practice location:
  • Phone: 269-370-9772
  • Fax: 269-375-6078
Mailing address:
  • Phone: 269-370-9772
  • Fax: 269-375-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE L STOVER
Title or Position: OWNER
Credential:
Phone: 269-370-9772