Healthcare Provider Details

I. General information

NPI: 1093622813
Provider Name (Legal Business Name): JOEL DON SIEBERSMA MA, LPC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 FONTAINE BLVD
FOUNTAIN CO
80817-1061
US

IV. Provider business mailing address

1930 W COLORADO AVE
COLORADO SPRINGS CO
80904-3839
US

V. Phone/Fax

Practice location:
  • Phone: 719-653-7776
  • Fax:
Mailing address:
  • Phone: 719-401-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0005944
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: