MEDICARE: CECILIA SIEGEL LPC

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	171M00000X	Case Manager/Care Coordinator		CA
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	E.2303721	OH

General Provider Information

NPI Number	:	1356849749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA SIEGEL LPC

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 NORTHWEST BLVD STE 140
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-1637
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:

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

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/25/2024

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