Provider Demographics
NPI:1184870859
Name:STILL WATERS COUNSELING
Entity type:Organization
Organization Name:STILL WATERS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-869-1074
Mailing Address - Street 1:1330 E CHERRY ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3429
Mailing Address - Country:US
Mailing Address - Phone:417-869-1074
Mailing Address - Fax:417-869-1074
Practice Address - Street 1:1330 E CHERRY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3429
Practice Address - Country:US
Practice Address - Phone:417-869-1074
Practice Address - Fax:417-869-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004005777251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health