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Organization

STILL WATERS MENTAL HEALTH SERVICES, LLC

Active
Other names
Still Waters Family Health Services
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BRADLEY J. SHAW CRNP (OWNER)
(814) 205-4025
Entity
Organization

Contact information

Practice address
216 N 2ND ST STE 5, CLEARFIELD, PA 16830-2547
(814) 205-4025
Mailing address
216 N 2ND ST STE 5, CLEARFIELD, PA 16830-2547
(814) 205-4025
(814) 240-6632

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
363LF0000X
Family Nurse Practitioner
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
103371103
PA
Enumeration date
04/21/2020
Last updated
04/05/2021
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