Provider Demographics
NPI:1306185988
Name:SIEBERT, PHYLLIS K (LCPC, CADC)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:K
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BAMBURG CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5243
Mailing Address - Country:US
Mailing Address - Phone:630-372-6599
Mailing Address - Fax:630-372-6697
Practice Address - Street 1:1240 BAMBURG CT
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5243
Practice Address - Country:US
Practice Address - Phone:630-372-6599
Practice Address - Fax:630-372-6697
Is Sole Proprietor?:No
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25239101YA0400X
IL180.008148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)