Provider Demographics
NPI:1508489428
Name:STILLWELL MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:STILLWELL MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STILLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-203-9111
Mailing Address - Street 1:5501 HIGHWAY 280 STE 302
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6536
Mailing Address - Country:US
Mailing Address - Phone:205-203-9111
Mailing Address - Fax:
Practice Address - Street 1:5501 HIGHWAY 280 STE 302
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6536
Practice Address - Country:US
Practice Address - Phone:205-203-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty