Healthcare Provider Details

I. General information

NPI: 1295757680
Provider Name (Legal Business Name): HELEN THERESE SEIFERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 W 600 N
WEST LAFAYETTE BRA IN
47906-9034
US

IV. Provider business mailing address

2504 W 600 N
WEST LAFAYETTE IN
47906
US

V. Phone/Fax

Practice location:
  • Phone: 765-714-2434
  • Fax: 765-497-2440
Mailing address:
  • Phone: 765-714-2434
  • Fax: 765-497-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003863A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: