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General NPI Number Information
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NPI Number | 1790218337
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Entity Type | Organization
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Legal Business Name | STOVER COUNSELING, PLLC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 1618 WILLIAMS DR SUITE 3
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City | GEORGETOWN
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State | TX
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Zip | 78628-3678
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Country | US
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Telephone | 512-964-4663
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 325
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City | COUPLAND
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State | TX
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Zip | 78615-0325
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Country | US
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Telephone | 512-964-4663
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MALLORY ROSE STOVER
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Credential | LPC
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Telephone | 512-964-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 73618
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License Number State | TX
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