MEDICARE: DIANA SILLENCE LMHC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5498	FL

General Provider Information

NPI Number	:	1770956385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANA SILLENCE LMHC PA

Provider Business Mailing Address
First Line	:	23108 CYPRESS TRAIL DR
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-8761
Country	:	US
Telephone Number	:	813-480-2180
Fax Number	:	813-200-3547

Provider Business Practice Location Address
First Line	:	27356 CASHFORD CIR
Second Line	:	SUITE #101
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6935
Country	:	US
Telephone Number	:	813-480-2180
Fax Number	:	813-200-3547

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. DIANA LYNN SILLENCE
Credential	:	LMHC
Telephone Number	:	813-480-2180

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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