Provider Demographics
NPI:1932960440
Name:NIKKI STILLO PHD PLLC
Entity Type:Organization
Organization Name:NIKKI STILLO PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:469-712-4522
Mailing Address - Street 1:1820 IDAHO DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5454
Mailing Address - Country:US
Mailing Address - Phone:972-741-1512
Mailing Address - Fax:
Practice Address - Street 1:1820 IDAHO DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5454
Practice Address - Country:US
Practice Address - Phone:972-741-1512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty