Healthcare Provider Details

I. General information

NPI: 1043676760
Provider Name (Legal Business Name): PERNILLE T SIEBERT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EMERSON AVE # B
SANTA BARBARA CA
93103-1917
US

IV. Provider business mailing address

2000 EMERSON AVE # B
SANTA BARBARA CA
93103-1917
US

V. Phone/Fax

Practice location:
  • Phone: 802-551-2516
  • Fax:
Mailing address:
  • Phone: 802-551-2516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: