Provider Demographics
NPI:1245455500
Name:LUCAS-SILVIS, LAURA ANNE (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANNE
Last Name:LUCAS-SILVIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 KILLARNEY LN S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1809
Mailing Address - Country:US
Mailing Address - Phone:952-922-2166
Mailing Address - Fax:952-903-9257
Practice Address - Street 1:6542 REGENCY LN
Practice Address - Street 2:SUITE 201
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7847
Practice Address - Country:US
Practice Address - Phone:952-903-9201
Practice Address - Fax:952-903-9257
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00030101YP2500X
CO2250101YP2500X
OH0001548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1A311LUOtherBCBS OF MN PAYEE ID