Provider Demographics
NPI:1922755149
Name:VILLANUEVA, STEPHANIE ALLISON
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALLISON
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 N COLLINS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-4557
Mailing Address - Country:US
Mailing Address - Phone:817-533-7081
Mailing Address - Fax:
Practice Address - Street 1:4140 N COLLINS ST STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-4557
Practice Address - Country:US
Practice Address - Phone:817-533-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician