MEDICARE: PERNILLE T SIEBERT LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1043676760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERNILLE T SIEBERT LMFT

Provider Business Mailing Address
First Line	:	2000 EMERSON AVE # B
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-1917
Country	:	US
Telephone Number	:	802-551-2516
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 EMERSON AVE # B
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-1917
Country	:	US
Telephone Number	:	802-551-2516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	09/29/2022

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