Healthcare Provider Details

I. General information

NPI: 1124445291
Provider Name (Legal Business Name): MARK SIEBERT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARK SIEBERT LCSW

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1458 E 820 N
OREM UT
84097
US

IV. Provider business mailing address

1458 E 820 N
OREM UT
84097
US

V. Phone/Fax

Practice location:
  • Phone: 801-860-4780
  • Fax: 385-375-6087
Mailing address:
  • Phone: 801-860-4780
  • Fax: 385-375-6087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5958473-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: