Organization
STILL WATERS COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACIE LEE STEPHENSON (OFFICE MANAGER)
(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
261Q00000X
Clinic/Center
Primary
LCSW261187
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8084327
—
ID
Enumeration date
05/18/2010
Last updated
05/18/2010
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