Provider Demographics
NPI:1902121775
Name:STILLO, SANDRA (PHD, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:STILLO
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 BABCOCK RD STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4428
Mailing Address - Country:US
Mailing Address - Phone:214-718-8341
Mailing Address - Fax:844-840-7304
Practice Address - Street 1:10300 N CENTRAL EXPY STE 322
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8656
Practice Address - Country:US
Practice Address - Phone:214-718-8341
Practice Address - Fax:844-840-7304
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX63361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health