Healthcare Provider Details

I. General information

NPI: 1659574804
Provider Name (Legal Business Name): BRANDI NICOLE SIEBERTZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 S WELLS ST STE 114
MERIDIAN ID
83642-7997
US

IV. Provider business mailing address

1236 E HARCOURT DR
BOISE ID
83702-1838
US

V. Phone/Fax

Practice location:
  • Phone: 208-971-3920
  • Fax:
Mailing address:
  • Phone: 541-551-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1581710
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: