Provider Demographics
NPI:1003154212
Name:STILL WATERS COUNSELING, PLLC
Entity Type:Organization
Organization Name:STILL WATERS COUNSELING, PLLC
Other - Org Name:STILL WATERS FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-263-7602
Mailing Address - Street 1:3313 W MOUNT COMFORT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5724
Mailing Address - Country:US
Mailing Address - Phone:479-263-7602
Mailing Address - Fax:479-443-2892
Practice Address - Street 1:3313 W MOUNT COMFORT RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5724
Practice Address - Country:US
Practice Address - Phone:479-263-7602
Practice Address - Fax:479-443-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0904023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty