Healthcare Provider Details

I. General information

NPI: 1609787167
Provider Name (Legal Business Name): SYDNEY SOELBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 S GILBERT RD STE 211
GILBERT AZ
85296-3441
US

IV. Provider business mailing address

55 S MESA DR UNIT 104
MESA AZ
85210-1447
US

V. Phone/Fax

Practice location:
  • Phone: 480-550-2873
  • Fax:
Mailing address:
  • Phone: 480-550-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-25084
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: