STILLWATER CENTER FOR WELLNESS PC (NPI# 1134787989) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134787989 |
| Entity Type | Organization |
| Organization Name | STILLWATER CENTER FOR WELLNESS PC |
| Practice Address |
435 W Washington St Springfield IL 62702-5006 |
| Mailing Address |
701 S Durkin Dr Ste B Springfield IL 62704-6030 |
| Practice Telephone | 2173035331 |
| Mailing Telephone | 2177267575 |
| Mailing Fax Number | 2177267577 |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-05 |
| Authorized Official Name | MR. DAVID VAIL (OWNER) |
| Authorized Official Telephone | 2173035331 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | Y |
| Parent Organization Name | STILLWATER CENTER FOR WELLNESS PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC1900X |
Psychologist Specialization: Counseling |
Behavioral Health & Social Service Providers | ||
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Thrive Center for Wellness | Doing Business As Name - Organization |
| Street Address |
435 W WASHINGTON ST |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-5006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780126169 | Michael Reeves | Social Worker | 435 W Washington St, Springfield, IL 62702-5006 | 2016-11-16 |
| 1366936239 | David R Vail | Counselor | 435 W Washington St, Springfield, IL 62702-5006 | 2018-06-14 |
| 1265954267 | Tara Marie Winkler | Counselor | 435 W Washington St, Springfield, IL 62702-5006 | 2017-07-11 |
| 1215473673 | Rebound Healthcare Systems LLC | Community/Behavioral Health | 435 W Washington St, Springfield, IL 62702-5006 | 2017-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629676929 | Katrina Louise Routh | Social Worker | 1310 E Kingsley St Ste B, Springfield, MO 65804-7238 | 2020-10-09 |
| 1194337022 | Loretta E. Buckwalter | Social Worker | 4401 Ridgewood Rd W, Springfield, OH 45503-6131 | 2020-08-21 |
| 1710596572 | Nichol Speciale | Social Worker | 3700 Kerry Blvd, Springfield, IL 62712-5858 | 2020-07-28 |
| 1124636162 | Sarah Ann Duffy | Social Worker | 6823 Floyd Ave, Springfield, VA 22150-2455 | 2020-07-15 |
| 1033736707 | Bernetta A Andrewin | Social Worker | 4481 Ash Grove Dr Ste A-d, Springfield, IL 62711-6358 | 2020-06-29 |
| 1013530856 | Christina Margaret White | Social Worker | 224 Springcreek Dr, Springfield, IL 62702-3469 | 2020-05-27 |
| 1295357192 | Luminary Counseling and Solutions, LLC | Social Worker | 319 E Madison St Ste 2c, Springfield, IL 62701-3120 | 2020-05-13 |
| 1861014326 | Marvin Merriweather Jr. | Social Worker | 510 E Apple Orchard Rd Ste 103, Springfield, IL 62703-4081 | 2020-05-07 |
| 1477182061 | Sean Edward Snyder | Social Worker | 578 Sheffield Dr, Springfield, PA 19064-2822 | 2020-04-06 |
| 1801429246 | David Aichroth Jr. | Social Worker | David Aichroth, 11 Dundar Rd Suite 105, Springfield, NJ 07081-2210 | 2020-02-13 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
Please comment or provide details below to improve the information on STILLWATER CENTER FOR WELLNESS PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.