Provider Demographics
NPI:1356467401
Name:KATHLEEN SIEGENTHALER
Entity Type:Organization
Organization Name:KATHLEEN SIEGENTHALER
Other - Org Name:FAMILY CENTERED COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIEGENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-773-0981
Mailing Address - Street 1:23271 LAWRENCE 2170
Mailing Address - Street 2:
Mailing Address - City:MARIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65705-8254
Mailing Address - Country:US
Mailing Address - Phone:417-773-0981
Mailing Address - Fax:
Practice Address - Street 1:206 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-2243
Practice Address - Country:US
Practice Address - Phone:417-773-0981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040111351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty