=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598633554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STILL WATERS PROFESSIONAL COUNSELING SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2025
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2420 MORRIS RD
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75941-4340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-404-9901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2420 MORRIS RD
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75941-4340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-404-9901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | AMBER CORTINES
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 936-404-9901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------