Provider Demographics
NPI:1528841525
Name:STILL WATERS COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:STILL WATERS COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEILYN
Authorized Official - Middle Name:ARIANA
Authorized Official - Last Name:GOATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:217-553-4120
Mailing Address - Street 1:4481 ASH GROVE DR STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6359
Mailing Address - Country:US
Mailing Address - Phone:309-270-3848
Mailing Address - Fax:
Practice Address - Street 1:4481 ASH GROVE DR STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6359
Practice Address - Country:US
Practice Address - Phone:309-270-3848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty