Provider Demographics
NPI:1518403807
Name:SIEMANN, EDIE (LMFT & LMHC)
Entity Type:Individual
Prefix:
First Name:EDIE
Middle Name:
Last Name:SIEMANN
Suffix:
Gender:F
Credentials:LMFT & LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 NW 41ST ST
Mailing Address - Street 2:J
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6667
Mailing Address - Country:US
Mailing Address - Phone:352-284-3747
Mailing Address - Fax:
Practice Address - Street 1:2830 NW 41ST ST
Practice Address - Street 2:J
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6667
Practice Address - Country:US
Practice Address - Phone:352-284-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11836101YM0800X
FLMT 2804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health