Provider Demographics
NPI:1972048635
Name:ILES, STEPHANIE ALEXANDRA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ALEXANDRA
Last Name:ILES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:STEPH
Other - Middle Name:
Other - Last Name:ILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:526 POINTE VISTA DR.
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854
Mailing Address - Country:US
Mailing Address - Phone:408-504-1909
Mailing Address - Fax:
Practice Address - Street 1:1522 NEW HOPE RD.
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854
Practice Address - Country:US
Practice Address - Phone:408-982-7059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CALMFT128777106H00000X
TNLMFT2084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist