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General NPI Number Information
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NPI Number | 1659991594
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Entity Type | Organization
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Legal Business Name | STILL WATERS MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 216 N 2ND ST STE 5
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City | CLEARFIELD
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State | PA
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Zip | 16830-2547
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Country | US
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Telephone | 814-205-4025
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Fax |
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Provider Business Mailing Address
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Address Line | 216 N 2ND ST STE 5
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City | CLEARFIELD
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State | PA
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Zip | 16830-2547
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Country | US
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Telephone | 814-205-4025
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Fax | 814-240-6632
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRADLEY J. SHAW
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Credential | CRNP
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Telephone | 814-205-4025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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