Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 20679 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 20679 | CA |
N | 102L00000X | Psychologist | PSY 20679 | CA |
N | 103T00000X | Psychologist | PSY 20679 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY 20679 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY 20679 | CA |
N | 103G00000X | Clinical Psychologist | PSY 20679 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 20679 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 20679 | CA |
N | 103TF0200X | Forensic Psychologist | PSY 20679 | CA |
N | 103TH0004X | Health Psychologist | PSY 20679 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY 20679 | CA |
N | 103TP2701X | Group Psychotherapist | PSY 20679 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY 20679 | CA |
NPI | 1164694774 |
---|---|
Provider Name | Dr. Laura Seibert |
First Address | Murrieta, CA 92562-5930 |
Second Address | Murrieta, CA 92562-5930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2008 |
Last Update Date | 15/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CT333A | MEDICARE PTAN (01) | CA |