Provider Demographics
NPI:1003014812
Name:SIPTAK, JIMMIE SUE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:JIMMIE
Middle Name:SUE
Last Name:SIPTAK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E SEALY ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2440
Mailing Address - Country:US
Mailing Address - Phone:281-585-0000
Mailing Address - Fax:281-585-0080
Practice Address - Street 1:107 E SEALY ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2440
Practice Address - Country:US
Practice Address - Phone:281-585-0000
Practice Address - Fax:281-585-0080
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6096101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional