Provider Demographics
NPI:1922711381
Name:SILVA, TRICIA L
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TRICIA
Other - Middle Name:L
Other - Last Name:BACA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846
Mailing Address - Country:US
Mailing Address - Phone:620-315-2949
Mailing Address - Fax:
Practice Address - Street 1:605 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846
Practice Address - Country:US
Practice Address - Phone:620-315-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician