Healthcare Provider Details

I. General information

NPI: 1104577881
Provider Name (Legal Business Name): AMBER HARRIS MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER SIEBOLD

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 KLONDIKE RD
GREEN BAY WI
54311-6708
US

IV. Provider business mailing address

2854 KLONDIKE RD
GREEN BAY WI
54311-6708
US

V. Phone/Fax

Practice location:
  • Phone: 920-973-9605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225530
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10582
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number93145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: