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General NPI Number Information
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NPI Number | 1003154212
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Entity Type | Organization
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Legal Business Name | STILL WATERS COUNSELING, PLLC
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 03/13/2021
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Provider Practice Location Address
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Address Line | 3313 W MOUNT COMFORT RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5724
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Country | US
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Telephone | 479-263-7602
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Fax | 479-443-2892
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Provider Business Mailing Address
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Address Line | 3313 W MOUNT COMFORT RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5724
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Country | US
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Telephone | 479-263-7602
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Fax | 479-443-2892
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDREW COOPER
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Credential | LPC
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Telephone | 479-263-7602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0904023
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License Number State | AR
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