Provider Demographics
NPI:1043047707
Name:STOVER, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:STOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880-1012
Mailing Address - Country:US
Mailing Address - Phone:304-395-2897
Mailing Address - Fax:
Practice Address - Street 1:11 CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-1012
Practice Address - Country:US
Practice Address - Phone:304-395-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling