Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 39002165A | IN |
NPI | 1003136888 |
---|---|
Provider Name | Marc Allen Siler |
First Address | Warsaw, IN 46580-3163 |
Second Address | Wabash, IN 46992-2705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 03/06/2010 |