Provider Demographics
NPI:1558642215
Name:VILLA, ALLENE (MFT)
Entity Type:Individual
Prefix:
First Name:ALLENE
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-9421
Mailing Address - Country:US
Mailing Address - Phone:805-904-8259
Mailing Address - Fax:
Practice Address - Street 1:218 CARMEN LN STE 108
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7773
Practice Address - Country:US
Practice Address - Phone:805-904-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health