Healthcare Provider Details

I. General information

NPI: 1710856141
Provider Name (Legal Business Name): ELIZABETH SEIBELS OGLETREE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 OFFICE PARK CIR STE 202
MOUNTAIN BRK AL
35223-2535
US

IV. Provider business mailing address

2871 BALMORAL RD
MOUNTAIN BRK AL
35223-1235
US

V. Phone/Fax

Practice location:
  • Phone: 205-837-0981
  • Fax:
Mailing address:
  • Phone: 205-837-0981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6557C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: