Provider Demographics
NPI:1023110889
Name:SEIBEL, STACEY L (PHD, LP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:SEIBEL
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 CENTRAL AVE NE APT 315
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4520
Mailing Address - Country:US
Mailing Address - Phone:651-231-9661
Mailing Address - Fax:612-626-8311
Practice Address - Street 1:1300 S 2ND ST
Practice Address - Street 2:#180
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1075
Practice Address - Country:US
Practice Address - Phone:612-625-1500
Practice Address - Fax:612-626-8311
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4742103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist