MEDICARE: MISS KANDIS A SILVESTRI MSED, LPC

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	LPC-12176	AZ
2	101Y00000X	Counselor	LPC12176	AZ

General Provider Information

NPI Number	:	1184771388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KANDIS A SILVESTRI MSED, LPC

Provider Business Mailing Address
First Line	:	2277 SWANSON AVE
Second Line	:	STE B
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5998
Country	:	US
Telephone Number	:	928-854-0110
Fax Number	:	928-854-0112

Provider Business Practice Location Address
First Line	:	2277 SWANSON AVE
Second Line	:	STE B
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5998
Country	:	US
Telephone Number	:	928-854-0110
Fax Number	:	928-854-0112

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	10/08/2010

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