Provider Demographics
NPI:1780938415
Name:SIEBEN, LISA MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SIEBEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 CHARLESTON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2109
Mailing Address - Country:US
Mailing Address - Phone:505-321-7579
Mailing Address - Fax:
Practice Address - Street 1:8100 MOUNTAIN RD NE
Practice Address - Street 2:200 B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7818
Practice Address - Country:US
Practice Address - Phone:505-380-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0149561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health