Healthcare Provider Details

I. General information

NPI: 1578425179
Provider Name (Legal Business Name): JOSE JUAN SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BIEDE AVE
DEFIANCE OH
43512-2497
US

IV. Provider business mailing address

211 BIEDE AVE
DEFIANCE OH
43512-2497
US

V. Phone/Fax

Practice location:
  • Phone: 419-782-8856
  • Fax:
Mailing address:
  • Phone: 419-782-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507258-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: