Basic Information
| Provider Information | |||||||||
| NPI: | 1942556352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEIBERT | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, LCSW, CSAYC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2159 MERIDIAN SPRINGS LN | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461407282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174982121 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 N TIBBS AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462224064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176305215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2012 | ||||||||
| LastUpdateDate: | 08/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34006546A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.