Provider Demographics
NPI:1922513761
Name:SHOUTED SILENCE SERVICES, LLC
Entity Type:Organization
Organization Name:SHOUTED SILENCE SERVICES, LLC
Other - Org Name:THE ANCHOR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:CONERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:601-650-8150
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-1111
Mailing Address - Country:US
Mailing Address - Phone:601-650-8150
Mailing Address - Fax:601-650-8150
Practice Address - Street 1:907 CARTER AVE STE 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3645
Practice Address - Country:US
Practice Address - Phone:601-650-8150
Practice Address - Fax:601-429-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06773349Medicaid
5605726OtherCIGNA