Provider Demographics
NPI:1972818342
Name:STILLWATER COUNSELING ASSOCIATES, PLLC
Entity type:Organization
Organization Name:STILLWATER COUNSELING ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:480-251-2156
Mailing Address - Street 1:935 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8874
Mailing Address - Country:US
Mailing Address - Phone:480-615-5921
Mailing Address - Fax:480-615-5921
Practice Address - Street 1:935 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8874
Practice Address - Country:US
Practice Address - Phone:480-615-5921
Practice Address - Fax:480-615-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-10704251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1407086754OtherNPI TYPE 1