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General NPI Number Information
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NPI Number | 1649670415
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Entity Type | Individual
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Provider Name | MARSHA SIEBENMORGEN PHD, LP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2014
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 2222 MEDICAL DISTRICT DR
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City | DALLAS
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State | TX
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Zip | 75235-8075
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Country | US
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Telephone | 214-867-6923
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 N ROCK RD #1608
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City | WICHITA
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State | KS
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Zip | 67226-1192
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Country | US
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Telephone | 918-293-2646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2567
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 37734
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License Number State | TX
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