Provider Demographics
NPI:1114482718
Name:SIEMER LLC
Entity Type:Organization
Organization Name:SIEMER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL-SIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-706-1728
Mailing Address - Street 1:1930 SANTA ANNA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5611
Mailing Address - Country:US
Mailing Address - Phone:817-706-1728
Mailing Address - Fax:
Practice Address - Street 1:1703 PEYCO DR N STE L
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-6701
Practice Address - Country:US
Practice Address - Phone:817-706-1728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1609349489OtherLORI RUSSELL-SIEMER