| Julie L Stover Llc | |
|
2083 Sandy Cove Dr Kalamazoo MI 49048-8201 | |
| (269) 370-9772 | |
| (269) 375-6078 |
| Full Name | Julie L Stover Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2083 Sandy Cove Dr, Kalamazoo, Michigan |
| Authorized Official Name and Position | Julie L Stover (OWNER) |
| Authorized Official Contact | 2693709772 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Julie L Stover Llc 2083 Sandy Cove Dr Kalamazoo MI 49048-8201 Ph: (269) 370-9772 | Julie L Stover Llc 2083 Sandy Cove Dr Kalamazoo MI 49048-8201 Ph: (269) 370-9772 |
| NPI Number | 1669183521 |
|---|---|
| Provider Enumeration Date | 12/12/2022 |
| Last Update Date | 05/16/2023 |
| Certification Date | 05/16/2023 |
| Medicare PECOS PAC ID | 2466819487 |
|---|---|
| Medicare Enrollment ID | O20230607001493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669183521 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | David L Russell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548362171 PECOS PAC ID: 1052484748 Enrollment ID: I20080714000280 |
| Provider Name | Julie L. Stover |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1881787315 PECOS PAC ID: 5193182111 Enrollment ID: I20240503000099 |
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