Healthcare Provider Details

I. General information

NPI: 1427163674
Provider Name (Legal Business Name): STEPHANY L. HILLMAN PHD, MP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6522 W MAIN ST
HOUMA LA
70360-2267
US

IV. Provider business mailing address

6522 W MAIN ST
HOUMA LA
70360-2267
US

V. Phone/Fax

Practice location:
  • Phone: 985-804-1521
  • Fax: 504-636-3923
Mailing address:
  • Phone: 985-804-1521
  • Fax: 504-636-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number43-696
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1168
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number310480
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: