MEDICARE: MS. LAURA ANNE LUCAS-SILVIS MS, 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	101YP2500X	Professional Counselor	00030	MN
2	101YP2500X	Professional Counselor	2250	CO
3	101YP2500X	Professional Counselor	0001548	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1A311LU	OTHER	MN	BCBS OF MN PAYEE ID

General Provider Information

NPI Number	:	1245455500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA ANNE LUCAS-SILVIS MS, LPC

Provider Business Mailing Address
First Line	:	5917 KILLARNEY LN S
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55436-1809
Country	:	US
Telephone Number	:	952-922-2166
Fax Number	:	952-903-9257

Provider Business Practice Location Address
First Line	:	6542 REGENCY LN
Second Line	:	SUITE 201
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7847
Country	:	US
Telephone Number	:	952-903-9201
Fax Number	:	952-903-9257

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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