Provider Demographics
NPI:1326109786
Name:SIEGEL, GLORIA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-3447
Mailing Address - Country:US
Mailing Address - Phone:901-683-1315
Mailing Address - Fax:
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:SUITE 940
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4701
Practice Address - Country:US
Practice Address - Phone:901-685-2148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical