Provider Demographics
NPI:1972241065
Name:STILL TIDES COUNSELING SERVICES, LTD
Entity Type:Organization
Organization Name:STILL TIDES COUNSELING SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-318-0040
Mailing Address - Street 1:2969 JACOB AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5122
Mailing Address - Country:US
Mailing Address - Phone:630-303-6315
Mailing Address - Fax:
Practice Address - Street 1:3380 LACROSSE LN STE 106
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8528
Practice Address - Country:US
Practice Address - Phone:630-318-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149019603OtherLICENSE
IL192527282OtherNPI