Healthcare Provider Details

I. General information

NPI: 1699818468
Provider Name (Legal Business Name): ANGELA STILLWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 CULLODEN MOORE
JACKSON MO
63755-4161
US

IV. Provider business mailing address

439 CULLODEN MOORE
JACKSON MO
63755-4161
US

V. Phone/Fax

Practice location:
  • Phone: 870-409-2377
  • Fax:
Mailing address:
  • Phone: 870-409-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026022790
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: