Organization
STILLWATERS COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN D STEPHENSON L.C.S.W (OWNER/THERAPIST)
(208) 782-0675
Entity
Organization
Contact information
Practice address
1309 CAMAS ST, BLACKFOOT, ID 83221-3060
(208) 782-0675
(208) 782-0678
Mailing address
PO BOX 903, BLACKFOOT, ID 83221-0903
(208) 782-0675
(208) 782-0678
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-261187
ID
251B00000X
Case Management Agency
LCSW-261187
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806939500
—
ID
Enumeration date
09/13/2006
Last updated
08/04/2014
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