Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 6096 | TX |
N | 101YP2500X | Professional Counselor | 6096 | TX |
NPI | 1003014812 |
---|---|
Provider Name | Ms. Jimmie Sue Siptak |
First Address | Alvin, TX 77511-2440 |
Second Address | Alvin, TX 77511-2440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |