NPIMap

Organization Active NPI

Still Water Professional Counseling, LLC

  • Professional Counselor
  • Midland, MI
National Provider Identifier
1609381631
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401013357 Issued in MI
Legal business name
STILL WATER PROFESSIONAL COUNSELING, LLC
Practice address
5100 Eastman Ave
Ste 2
Midland, MI 48640
Phone
(989) 832-0191
Fax
(989) 486-9413
NPI assigned
Dec 13, 2017
Last updated
Dec 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Authorized official

Name
Paul R Boothroyd Jr., LPCNPI 1538524244
Title
Sole MBR
Phone
(989) 832-0191

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401013357 MI Primary

Addresses

Primary practice location

5100 Eastman Ave
Ste 2
Midland, MI 48640

Mailing address

5100 Eastman Ave
Ste 2
Midland, MI 48640
Phone (989) 832-0191

National Provider Directory

National Provider Directory

Locations

2528 W Wackerly St
Midland, MI 48640
Phone (989) 832-0191

5100 Eastman Ave
Ste 2
Midland, MI 48640
Phone (989) 631-4092

Practitioners & affiliated clinicians

Practitioners 10

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": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1609381631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 EASTMAN AVE",
            "address_2": "STE 2",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-832-0191",
            "fax_number": "989-486-9413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 EASTMAN AVE",
            "address_2": "STE 2",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-832-0191",
            "fax_number": "989-486-9413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILL WATER PROFESSIONAL COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "BOOTHROYD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "989-832-0191",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401013357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.