Provider Demographics
NPI:1447594270
Name:SANTILLANA, GODFREY (LPC)
Entity Type:Individual
Prefix:
First Name:GODFREY
Middle Name:
Last Name:SANTILLANA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:GODFREY
Other - Middle Name:
Other - Last Name:SANTILLANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:5117 SARASOTA DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2879
Mailing Address - Country:US
Mailing Address - Phone:214-597-1757
Mailing Address - Fax:
Practice Address - Street 1:5117 SARASOTA DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2879
Practice Address - Country:US
Practice Address - Phone:214-597-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63331101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health