Provider Demographics
NPI:1366740540
Name:SILVA, SHANNON ANN (MFT)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:ANN
Last Name:SILVA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SOQUEL AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2342
Mailing Address - Country:US
Mailing Address - Phone:831-688-9541
Mailing Address - Fax:
Practice Address - Street 1:555 SOQUEL AVE STE 340
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2342
Practice Address - Country:US
Practice Address - Phone:831-688-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health