Provider Demographics
NPI:1831392182
Name:SIBERT, TERESA KAY (NCC LICDC PCCS)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:KAY
Last Name:SIBERT
Suffix:
Gender:F
Credentials:NCC LICDC PCCS
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Mailing Address - Street 1:96 GRAHAM RD
Mailing Address - Street 2:SUITE A RESERVE PSYCHOLOGICAL CONSULTANTS INC
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223
Mailing Address - Country:US
Mailing Address - Phone:330-929-1326
Mailing Address - Fax:330-929-1324
Practice Address - Street 1:96 GRAHAM RD
Practice Address - Street 2:SUITE A RESERVE PSYCHOLOGICAL CONSULTANTS INC
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223
Practice Address - Country:US
Practice Address - Phone:330-929-1326
Practice Address - Fax:330-929-1324
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH021004LICDCCHEMICALD101YA0400X
PWE3930PCCSUPERVISOR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)