Provider Demographics
NPI:1376730440
Name:SANTIAGO, PANISILVAM (LMFT)
Entity Type:Individual
Prefix:MR
First Name:PANISILVAM
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4899
Mailing Address - Country:US
Mailing Address - Phone:515-432-7983
Mailing Address - Fax:515-432-7657
Practice Address - Street 1:105 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4899
Practice Address - Country:US
Practice Address - Phone:515-432-7983
Practice Address - Fax:515-432-7657
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist