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1730116187

NPI Code Detail

MEDICARE: STILL WATERS HOLDINGS

MEDICARE: STILL WATERS HOLDINGS

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	101YP2500X	Professional Counselor
2	103TC1900X	Counseling Psychologist	20041894A	IN
3	103TC1900X	Counseling Psychologist	20041851A	IN
4	103TC1900X	Counseling Psychologist	20041828A	IN
5	103TC1900X	Counseling Psychologist
6	104100000X	Social Worker
7	1041C0700X	Clinical Social Worker
8	106H00000X	Marriage & Family Therapist	35001519A	IN
9	106H00000X	Marriage & Family Therapist
10	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	740738000	OTHER	IN	MAGELLAN HEALTH SERVICES

General Provider Information

NPI Number	:	1730116187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILL WATERS HOLDINGS

Provider Business Mailing Address
First Line	:	3301 W PURDUE AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-6356
Country	:	US
Telephone Number	:	765-284-0043
Fax Number	:	765-284-4112

Provider Business Practice Location Address
First Line	:	3301 W PURDUE AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-6356
Country	:	US
Telephone Number	:	765-284-0043
Fax Number	:	765-284-4112

Authorized Official
Title or Position	:	OWNER
Name	:	MEREDITH BOATWRIGHT
Credential	:
Telephone Number	:	765-284-0043

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/14/2024

Similar Medicare Providers

1275488736 — KAYLA ELIZABETH MYERS
Practice Location Address:

3301 W PURDUE AVE
MUNCIE, IN
47304-6356

Practice Phone: 765-284-0043
Practice Fax:

1083759336 — KRISTIN PERRONE PH.D., H.S.P.P.
Practice Location Address:

3301 W PURDUE AVE
MUNCIE, IN
47304-6356

Practice Phone: 765-284-0043
Practice Fax:

1558739755 — MRS. JENNIFER S STEFANOVSKI LPC
Practice Location Address:

3301 W PURDUE AVE
MUNCIE, IN
47304-6356

Practice Phone: 765-284-0043
Practice Fax: 765-284-4112

1285255190 — BRITNI NICOLE SWARTZ
Practice Location Address:

3301 W PURDUE AVE
MUNCIE, IN
47304-6356

Practice Phone: 765-284-0043
Practice Fax:

1407745961 — REGINA BRADBURN LSW
Practice Location Address:

3301 W PURDUE AVE
MUNCIE, IN
47304-6356

Practice Phone: 765-284-0043
Practice Fax:

1316805765 — BRITTANY KIGER
Practice Location Address:

3301 W PURDUE AVE
MUNCIE, IN
47304-6356

Practice Phone: 765-284-0043
Practice Fax:

Directions to “STILL WATERS HOLDINGS ” Practice Location

Language	Start Address	Practice Location

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