Healthcare Provider Details

I. General information

NPI: 1093512410
Provider Name (Legal Business Name): SIRRE GEPPERT LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIRRE RADTKE

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 MAIN ST STE 300
FRISCO TX
75033-3082
US

IV. Provider business mailing address

4280 MAIN ST STE 300
FRISCO TX
75033-3082
US

V. Phone/Fax

Practice location:
  • Phone: 972-905-6574
  • Fax: 972-423-8918
Mailing address:
  • Phone: 972-905-6574
  • Fax: 972-423-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: