MEDICARE: NICHOLE EILEEN VILLASANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	10940	AZ

General Provider Information

NPI Number	:	1669330361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE EILEEN VILLASANA

Provider Business Mailing Address
First Line	:	1715 W NIDO AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4535 S LAKESHORE DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-8340
Country	:	US
Telephone Number	:	480-803-7334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ NICHOLE EILEEN VILLASANA ” Practice Location

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