Healthcare Provider Details

I. General information

NPI: 1245506955
Provider Name (Legal Business Name): KATHLEEN MARIE SEIFERT LMT;CCMT;
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10718 W BUCCANEER WAY
SUN CITY AZ
85351-2650
US

IV. Provider business mailing address

10718 W BUCCANEER WAY
SUN CITY AZ
85351-2650
US

V. Phone/Fax

Practice location:
  • Phone: 623-243-5678
  • Fax:
Mailing address:
  • Phone: 623-243-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCCMT 29473
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberMT 04907
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: