MEDICARE: SARAH JAYNE STILLWELL LCDC, LPC-INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13972	TX
2	101YM0800X	Mental Health Counselor	78099	TX

General Provider Information

NPI Number	:	1285146035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JAYNE STILLWELL LCDC, LPC-INTERN

Provider Business Mailing Address
First Line	:	11213 PATTI LN
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-2009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 MAIN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4360
Country	:	US
Telephone Number	:	214-331-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	11/02/2017

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