=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891560611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CBOK SOLUTIONS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2023
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 RAEFORD RD STE B
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28305-5092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-295-0364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4239 CAMERON RD
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-7106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-295-0364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SOLE PROVIDER
-----------------------------------------------------
Name | KELLSIE SIEBACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-295-0364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------