Healthcare Provider Details

I. General information

NPI: 1679410690
Provider Name (Legal Business Name): THOMAS SEIBERT CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 S 700 E
SALT LAKE CITY UT
84106-1182
US

IV. Provider business mailing address

3802 S 700 E
SALT LAKE CITY UT
84106-1182
US

V. Phone/Fax

Practice location:
  • Phone: 801-879-7112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13396948-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: