Provider Demographics
NPI:1841438801
Name:STILLWATERS BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:STILLWATERS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RIEHM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-587-5631
Mailing Address - Street 1:303 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1843
Mailing Address - Country:US
Mailing Address - Phone:630-587-5631
Mailing Address - Fax:630-587-5631
Practice Address - Street 1:303 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1843
Practice Address - Country:US
Practice Address - Phone:630-587-5631
Practice Address - Fax:630-587-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0055741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty