Provider Demographics
NPI:1184459547
Name:STILL WATERS BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:STILL WATERS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-367-9509
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-0672
Mailing Address - Country:US
Mailing Address - Phone:606-367-9509
Mailing Address - Fax:
Practice Address - Street 1:2340 KY ROUTE 2039
Practice Address - Street 2:
Practice Address - City:HAGERHILL
Practice Address - State:KY
Practice Address - Zip Code:41222
Practice Address - Country:US
Practice Address - Phone:606-367-9509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty