MEDICARE: DR. BRIAN NATHAN SILLANPAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164875241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN NATHAN SILLANPAA

Provider Business Mailing Address
First Line	:	4801 S LAKESHORE DR STE 106
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7156
Country	:	US
Telephone Number	:	480-525-0058
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 S LAKESHORE DR STE 106
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7156
Country	:	US
Telephone Number	:	480-525-0058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	02/06/2024

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