Provider Information for 1851419121
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Mr. MARK ANTHONY SILLA LPCC
Sex: Male
NPI: 1851419121
Last Updated: 2012-11-02
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1851419121 | ||||||||
| Enumeration Date | 2007-03-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 833 TUCUMCARI, NM 88401-0833 United States Phone: 575-708-0033 | Fax: | ||||||||
| Primary Practice Address | 6276 TERRELL DR TUCUMCARI, NM 88401-9547 United States Phone: 505-708-0033 | Fax: | ||||||||
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