NPIMap

Organization Active NPI

Stillwaters Counseling LLC

  • Mental Health Counselor
  • Blackfoot, ID
National Provider Identifier
1275638645
Registry record updated Aug 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LCSW-261187 Issued in ID
Legal business name
STILLWATERS COUNSELING LLC
Practice address
1309 Camas St
Blackfoot, ID 83221-3060
Phone
(208) 782-0675
Fax
(208) 782-0678
NPI assigned
Sep 13, 2006
Last updated
Aug 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John D Stephenson, L.C.S.WNPI 1528126158
Title
Owner/Therapist
Phone
(208) 782-0675

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X LCSW-261187 ID Primary
Case Management Agency 251B00000X LCSW-261187 ID

Addresses

Primary practice location

1309 Camas St
Blackfoot, ID 83221-3060

Mailing address

PO Box 903
Blackfoot, ID 83221-0903
Phone (208) 782-0675

Other identifiers 1

IdentifierTypeStateIssuer
806939500MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041020000373 ID Part B Supplier - Clinic/Group Practice 2466412051 Receives reassigned benefits from 2 practitioners
Practice locations: Blackfoot, ID

National Provider Directory

National Provider Directory
Tax ID family
Stillwaters Counseling LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

745 W Bridge St
Ste D
Blackfoot, ID 83221
Phone (208) 782-0675

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407110400000",
    "number": "1275638645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 903",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832210903",
            "telephone_number": "208-782-0675",
            "fax_number": "208-782-0678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 CAMAS ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832213060",
            "telephone_number": "208-782-0675",
            "fax_number": "208-782-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATERS COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2014-08-04",
        "status": "A",
        "authorized_official_last_name": "STEPHENSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "208-782-0675",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.C.S.W"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCSW-261187",
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "ID",
            "license": "LCSW-261187",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806939500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackfoot, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.