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General NPI Number Information
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NPI Number | 1285352872
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Entity Type | Organization
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Legal Business Name | SLV GROUP, LLC
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 1132 28TH AVE S STE 102
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City | MOORHEAD
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State | MN
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Zip | 56560-4420
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Country | US
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Telephone | 218-512-0630
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 28TH AVE S STE 102
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City | MOORHEAD
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State | MN
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Zip | 56560-4420
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Country | US
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Telephone | 218-512-0630
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. AMY LAVALLA
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Credential | DNP, PMHNP-BC, APRN
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Telephone | 218-512-0630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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