Healthcare Provider Details

I. General information

NPI: 1386274223
Provider Name (Legal Business Name): SERENITY GRACE MICHELLE SILVERS LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48623 LAKE AVE
MCGREGOR MN
55760-4526
US

IV. Provider business mailing address

48623 LAKE AVE
MCGREGOR MN
55760-4526
US

V. Phone/Fax

Practice location:
  • Phone: 651-419-6960
  • Fax: 651-560-3898
Mailing address:
  • Phone: 651-419-6960
  • Fax: 651-560-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305765
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3629
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: