Basic Information
| Provider Information | |||||||||
| NPI: | 1679841639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOLL | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 S VALLEY VIEW BLVD | ||||||||
| Address2: | SUITE #6 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891020116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029227015 | ||||||||
| FaxNumber: | 7029226600 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 S VALLEY VIEW BLVD | ||||||||
| Address2: | SUITE #6 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891020116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029227015 | ||||||||
| FaxNumber: | 7029226600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2011 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MI0281 | NV | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.