1730116187 NPI number — STILL WATERS HOLDINGS

Table of content: (NPI 1730116187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730116187 NPI number — STILL WATERS HOLDINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STILL WATERS HOLDINGS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STILL WATERS PROFESSIONAL COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730116187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 W PURDUE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-6356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-284-0043
Provider Business Mailing Address Fax Number:
765-284-4112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 W PURDUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47304-6356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-284-0043
Provider Business Practice Location Address Fax Number:
765-284-4112
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOATWRIGHT
Authorized Official First Name:
MEREDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
765-284-0043

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: 20041894A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: 20041851A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: 20041828A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 35001519A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 740738000 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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