Provider Demographics
NPI:1831683796
Name:SIEBACH, KELLSIE RAE (LMFT)
Entity type:Individual
Prefix:
First Name:KELLSIE
Middle Name:RAE
Last Name:SIEBACH
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7106
Mailing Address - Country:US
Mailing Address - Phone:919-295-0364
Mailing Address - Fax:
Practice Address - Street 1:4239 CAMERON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-7106
Practice Address - Country:US
Practice Address - Phone:919-295-0364
Practice Address - Fax:844-321-8479
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist