Provider Demographics
NPI:1982764072
Name:SILVERTHORN, PERSEPHANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PERSEPHANIE
Middle Name:
Last Name:SILVERTHORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 HAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-4437
Mailing Address - Country:US
Mailing Address - Phone:985-661-8400
Mailing Address - Fax:985-643-7454
Practice Address - Street 1:887 HAILEY AVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4437
Practice Address - Country:US
Practice Address - Phone:985-661-8400
Practice Address - Fax:985-643-7454
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical