Healthcare Provider Details

I. General information

NPI: 1740330117
Provider Name (Legal Business Name): BLYTHE JANE SILANO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 CAMINO DE CHELLY
SANTA FE NM
87505-6261
US

IV. Provider business mailing address

933 CAMINO DE CHELLY
SANTA FE NM
87505-6261
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-1548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0095311
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: