Provider Demographics
NPI:1104335470
Name:STILL WATERS COUNSELING
Entity type:Organization
Organization Name:STILL WATERS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BLODGETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-834-5408
Mailing Address - Street 1:427 F ST STE 205
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1040
Mailing Address - Country:US
Mailing Address - Phone:707-834-5408
Mailing Address - Fax:707-443-4519
Practice Address - Street 1:2910 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4811
Practice Address - Country:US
Practice Address - Phone:707-834-5408
Practice Address - Fax:707-443-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1285969436OtherBOARD OF BEHAVIORAL SERVICES