Healthcare Provider Details

I. General information

NPI: 1184771388
Provider Name (Legal Business Name): KANDIS A SILVESTRI MSED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 SWANSON AVE STE B
LAKE HAVASU CITY AZ
86403-5998
US

IV. Provider business mailing address

2277 SWANSON AVE STE B
LAKE HAVASU CITY AZ
86403-5998
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-0110
  • Fax: 928-854-0112
Mailing address:
  • Phone: 928-854-0110
  • Fax: 928-854-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC12176
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-12176
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: