Provider Demographics
NPI:1962271460
Name:JUSTIN STILSON LLC
Entity type:Organization
Organization Name:JUSTIN STILSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-746-7313
Mailing Address - Street 1:4345 FEIDLER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506
Mailing Address - Country:US
Mailing Address - Phone:814-746-7313
Mailing Address - Fax:
Practice Address - Street 1:3910 CAUGHEY RD STE 200
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4098
Practice Address - Country:US
Practice Address - Phone:814-746-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty