Provider Demographics
NPI:1376140343
Name:STILLWATERS COUNSELING OF SWFL
Entity Type:Organization
Organization Name:STILLWATERS COUNSELING OF SWFL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-204-9038
Mailing Address - Street 1:1720 EL JOBEAN RD UNIT 200
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1279
Mailing Address - Country:US
Mailing Address - Phone:941-889-7875
Mailing Address - Fax:
Practice Address - Street 1:1720 EL JOBEAN RD UNIT 200
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1279
Practice Address - Country:US
Practice Address - Phone:941-889-7875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty