Healthcare Provider Details

I. General information

NPI: 1780501213
Provider Name (Legal Business Name): STEPHANY VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16630 N DALE MABRY HWY
TAMPA FL
33618-1400
US

IV. Provider business mailing address

4522 W VILLAGE DR
TAMPA FL
33624-3429
US

V. Phone/Fax

Practice location:
  • Phone: 813-358-2731
  • Fax:
Mailing address:
  • Phone: 813-358-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH24637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: