Provider Demographics
NPI:1437440443
Name:STILSON, JOHNNA (LMHC)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:
Last Name:STILSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4047 IRIS ST N APT 332
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5639
Mailing Address - Country:US
Mailing Address - Phone:813-610-3963
Mailing Address - Fax:
Practice Address - Street 1:4047 IRIS ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-5639
Practice Address - Country:US
Practice Address - Phone:813-610-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health