Healthcare Provider Details

I. General information

NPI: 1285542878
Provider Name (Legal Business Name): STILLWATER BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 W 19TH ST
COSTA MESA CA
92627-8600
US

IV. Provider business mailing address

657 W 19TH ST
COSTA MESA CA
92627-8600
US

V. Phone/Fax

Practice location:
  • Phone: 949-233-3983
  • Fax:
Mailing address:
  • Phone: 949-233-3983
  • Fax: 949-767-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN BENNETT
Title or Position: COO
Credential:
Phone: 949-233-3983