Healthcare Provider Details

I. General information

NPI: 1356727945
Provider Name (Legal Business Name): MOIRIA ELAINE SEIBER P.L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 STATE ROUTE U
WILLOW SPRINGS MO
65793-3426
US

IV. Provider business mailing address

5686 COUNTY ROAD 1820
WEST PLAINS MO
65775-5496
US

V. Phone/Fax

Practice location:
  • Phone: 417-293-2668
  • Fax: 417-469-0456
Mailing address:
  • Phone: 417-293-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015026837
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: