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General NPI Number Information
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NPI Number | 1275638645
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Entity Type | Organization
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Legal Business Name | STILLWATERS COUNSELING LLC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 1309 CAMAS ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-3060
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Country | US
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Telephone | 208-782-0675
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Fax | 208-782-0678
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Provider Business Mailing Address
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Address Line | PO BOX 903
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City | BLACKFOOT
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State | ID
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Zip | 83221-0903
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Country | US
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Telephone | 208-782-0675
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Fax | 208-782-0678
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. JOHN D STEPHENSON
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Credential | L.C.S.W
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Telephone | 208-782-0675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LCSW-261187
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW-261187
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License Number State | ID
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