Jennifer Faddis, MS, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

P0301002 Issued in AR

Practice address

3980 W Wedington Dr Ste 9
Fayetteville, AR 72704-5791

Phone

(479) 263-7602

NPI assigned

Dec 21, 2015

Last updated

Dec 21, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Still Waters Counseling, PLLC

  dba Still Waters Family Counseling

  • Professional Counselor
  • Fayetteville, AR
  • NPI 1003154212
  NPD (past)

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

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450656000000",
    "number": "1356706238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 203",
            "city": "CENTERTON",
            "state": "AR",
            "postal_code": "72719",
            "telephone_number": "479-903-1263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3980 W WEDINGTON DR STE 9",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727045791",
            "telephone_number": "479-263-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADDIS",
        "first_name": "JENNIFER",
        "credential": "MS, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-21",
        "last_updated": "2015-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "P0301002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eye Center, PA
• Eyemart Express LLC
• Eyemart Express, LTD
• Richard Ivy Ezell, D.D.S.
• Sally Lynn Ezell
• William Vernon Fairchild, MD
• Martin Thomas Faitak, PH.D.
• Benjamin B Falkner
• Family Dentistry of the Ozarks
• Dawn M Farley

• Counselor in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.