Provider Demographics
NPI:1558797621
Name:SIBERT, TARA NOEL (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:NOEL
Last Name:SIBERT
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19521 SIERRA CANON RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3802
Mailing Address - Country:US
Mailing Address - Phone:310-614-7823
Mailing Address - Fax:
Practice Address - Street 1:19521 SIERRA CANON RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-3802
Practice Address - Country:US
Practice Address - Phone:310-614-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50761106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist