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General NPI Number Information
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NPI Number | 1902121775
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Entity Type | Individual
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Provider Name | SANDRA STILLO PH.D., LPC-S
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Gender | Female
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 10300 N CENTRAL EXPY STE 322
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City | DALLAS
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State | TX
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Zip | 75231-8656
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Country | US
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Telephone | 214-718-8341
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Fax | 844-840-7304
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Provider Business Mailing Address
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Address Line | 2040 BABCOCK RD STE 303
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4428
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Country | US
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Telephone | 214-718-8341
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Fax | 844-840-7304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 63361
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License Number State | TX
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