MEDICARE: LOIS SILLAMAN LICENSED PROFESSIONAL COUNSELOR

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	:	1841175742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOIS SILLAMAN LICENSED PROFESSIONAL COUNSELOR

Provider Business Mailing Address
First Line	:	3130 ELIZABETH AVE
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9142
Country	:	US
Telephone Number	:	719-275-4409
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 ELIZABETH AVE
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9142
Country	:	US
Telephone Number	:	719-275-4409
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LOIS SILLAMAN
Credential	:
Telephone Number	:	719-275-4409

Provider Enumeration Date	:	08/08/2025
Last Update Date	:	08/08/2025

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