Healthcare Provider Details

I. General information

NPI: 1205754884
Provider Name (Legal Business Name): STEPHANIE M VILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W CHARLESTON BLVD STE 300
LAS VEGAS NV
89102-2313
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD STE 300
LAS VEGAS NV
89102-2313
US

V. Phone/Fax

Practice location:
  • Phone: 702-251-8000
  • Fax: 702-471-0120
Mailing address:
  • Phone: 702-251-8000
  • Fax: 702-471-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC-3022
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: