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General NPI Number Information
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NPI Number | 1831808047
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Entity Type | Organization
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Legal Business Name | OUR CREATED LIVES LLC
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 2454 MORGAN LN
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City | GREEN BAY
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State | WI
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Zip | 54311-5509
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Country | US
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Telephone | 920-245-5090
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Fax |
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Provider Business Mailing Address
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Address Line | 2454 MORGAN LN
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City | GREEN BAY
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State | WI
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Zip | 54311-5509
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Country | US
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Telephone | 920-245-5090
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | SARAH SIEBERT
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Credential | MA, LPC
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Telephone | 920-245-5090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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