Individual
TINA STILLWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
619 COURT ST, CLAY CENTER, KS 67432-2607
(785) 630-5500
(785) 630-5295
Mailing address
619 COURT ST, CLAY CENTER, KS 67432-2607
(785) 630-5500
(785) 630-5295
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
80-057-2059
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200656790A
MEDICAID
KS
05
—
200656790A
—
KS
05
—
KA1795
—
KS
Enumeration date
06/30/2009
Last updated
11/10/2022
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