Provider Demographics
NPI:1649670415
Name:SIEBENMORGEN, MARSHA (PHD, LP)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:SIEBENMORGEN
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 1:2801 N ROCK RD
Mailing Address - Street 2:#1608
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1192
Mailing Address - Country:US
Mailing Address - Phone:918-293-2646
Mailing Address - Fax:
Practice Address - Street 1:2222 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-8075
Practice Address - Country:US
Practice Address - Phone:214-867-6923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2567103TC0700X
TX37734103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical