Provider Demographics
NPI:1366582538
Name:STOCK, DENNIS THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:THOMAS
Last Name:STOCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 W AZURE DR
Mailing Address - Street 2:# 259
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-4416
Mailing Address - Country:US
Mailing Address - Phone:702-367-0393
Mailing Address - Fax:702-367-1067
Practice Address - Street 1:7495 W AZURE DR
Practice Address - Street 2:# 259
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4416
Practice Address - Country:US
Practice Address - Phone:702-367-0393
Practice Address - Fax:702-367-1067
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2602010Medicaid
NV33875Medicare ID - Type Unspecified