Provider Demographics
NPI:1295280105
Name:VILLAFANA, CODY (LPC, LCDC, NCC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:VILLAFANA
Suffix:
Gender:M
Credentials:LPC, LCDC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8626 TESORO DR
Mailing Address - Street 2:STE. 806
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6207
Mailing Address - Country:US
Mailing Address - Phone:210-281-5491
Mailing Address - Fax:
Practice Address - Street 1:8626 TESORO DR
Practice Address - Street 2:STE. 806
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6207
Practice Address - Country:US
Practice Address - Phone:210-281-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13562101YA0400X
TX71616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)