Provider Demographics
NPI:1063618809
Name:STILLA, JESSICA LEIGH (LMHC, ATR-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:STILLA
Suffix:
Gender:F
Credentials:LMHC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BENNING DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2432
Mailing Address - Country:US
Mailing Address - Phone:850-710-0295
Mailing Address - Fax:833-208-6587
Practice Address - Street 1:120 BENNING DR STE 1
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2432
Practice Address - Country:US
Practice Address - Phone:850-710-0295
Practice Address - Fax:833-208-6587
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600138101YP2500X
OHE.0600138101YP2500X
NC08-135221700000X
FLMH10748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist