Provider Demographics
NPI:1225495096
Name:STILL WATERS BEHAVIORAL HEALTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:STILL WATERS BEHAVIORAL HEALTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DE'ANGELO
Authorized Official - Middle Name:LOMAR
Authorized Official - Last Name:CANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-550-8649
Mailing Address - Street 1:500 N RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1082
Mailing Address - Country:US
Mailing Address - Phone:702-550-8649
Mailing Address - Fax:
Practice Address - Street 1:500 N RAINBOW BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1082
Practice Address - Country:US
Practice Address - Phone:702-550-8649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141429518251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health