Healthcare Provider Details

I. General information

NPI: 1326938655
Provider Name (Legal Business Name): STILLWATERS RELATIONAL AND BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 GULLY PASS DR
WASHINGTON TOWNSHIP OH
45458-4360
US

IV. Provider business mailing address

10109 GULLY PASS DR
WASHINGTON TOWNSHIP OH
45458-4360
US

V. Phone/Fax

Practice location:
  • Phone: 513-339-6396
  • Fax:
Mailing address:
  • Phone: 513-339-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: KELLY HIBBETT
Title or Position: BILLING SPECIALIST
Credential:
Phone: 513-482-1624