Provider Demographics
NPI:1760644041
Name:STILLWATER CENTER FOR FAMILY THERAPY
Entity Type:Organization
Organization Name:STILLWATER CENTER FOR FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICXENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-867-4123
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89407-0370
Mailing Address - Country:US
Mailing Address - Phone:775-867-4123
Mailing Address - Fax:775-867-4914
Practice Address - Street 1:158 S TAYLOR ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3261
Practice Address - Country:US
Practice Address - Phone:775-867-4123
Practice Address - Fax:775-867-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0436103T00000X
NV2940-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty