Provider Demographics
NPI:1629134390
Name:SIVILS, PAULA S (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:S
Last Name:SIVILS
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 1:1320 E KINGSLEY ST
Mailing Address - Street 2:STE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7216
Mailing Address - Country:US
Mailing Address - Phone:417-882-4110
Mailing Address - Fax:417-882-4155
Practice Address - Street 1:1320 E KINGSLEY ST
Practice Address - Street 2:STE A
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7216
Practice Address - Country:US
Practice Address - Phone:417-882-4110
Practice Address - Fax:417-882-4155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health