Provider Demographics
NPI:1073917431
Name:SIBERT, RAYMOND EUGENE (MMFT, LPC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EUGENE
Last Name:SIBERT
Suffix:
Gender:M
Credentials:MMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 BAYLOR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4104
Mailing Address - Country:US
Mailing Address - Phone:512-468-2365
Mailing Address - Fax:
Practice Address - Street 1:1211 BAYLOR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4104
Practice Address - Country:US
Practice Address - Phone:512-468-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional