Provider Demographics
NPI:1336412238
Name:STILLMAN, ANGELA (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N CARROLL AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6454
Mailing Address - Country:US
Mailing Address - Phone:682-233-4673
Mailing Address - Fax:
Practice Address - Street 1:420 N CARROLL AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6454
Practice Address - Country:US
Practice Address - Phone:682-233-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66354101YP2500X
TX201543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional