Still Waters Counseling

Key facts

NPI

1699261990

Entity type

Organization (NPI type 2)

Primary specialty

Mental Health Counselor 101YM0800X

License

R4884 (OR)

Legal business name

STILL WATERS COUNSELING

Practice address

442 NW Wade Street
Estacada, OR 97023

Phone

(541) 561-8127

NPI assigned

Jul 10, 2018

Organization subpart

No

Authorized official

Name

Antonio Clifton Long-Drew, REGISTERED LPC INTER

Title

Owner/Operator

Phone

(541) 561-8127

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 10, 2018.

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531180800000",
    "number": "1699261990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 NW WADE ST",
            "city": "ESTACADA",
            "state": "OR",
            "postal_code": "970239744",
            "telephone_number": "541-561-8127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "442 NW WADE STREET",
            "city": "ESTACADA",
            "state": "OR",
            "postal_code": "97023",
            "telephone_number": "541-561-8127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILL WATERS COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-10",
        "last_updated": "2018-07-10",
        "status": "A",
        "authorized_official_last_name": "LONG-DREW",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "CLIFTON",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "541-561-8127",
        "authorized_official_credential": "REGISTERED LPC INTER"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R4884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Estacada, OR · Mental Health Counselor in Oregon