Healthcare Provider Details

I. General information

NPI: 1063618809
Provider Name (Legal Business Name): JESSICA LEIGH STILLA LMHC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BENNING DR STE 1
DESTIN FL
32541-2432
US

IV. Provider business mailing address

120 BENNING DR STE 1
DESTIN FL
32541-2432
US

V. Phone/Fax

Practice location:
  • Phone: 850-710-0295
  • Fax: 833-208-6587
Mailing address:
  • Phone: 850-710-0295
  • Fax: 833-208-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0600138
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0600138
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number08-135
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: