Provider Demographics
NPI:1316388200
Name:SILVA-BASS, MIRELLA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MIRELLA
Middle Name:
Last Name:SILVA-BASS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1255
Mailing Address - Country:US
Mailing Address - Phone:954-274-4343
Mailing Address - Fax:
Practice Address - Street 1:2250 NW 136 AVE # 100F
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-336-6044
Practice Address - Fax:954-212-0477
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health