Provider Demographics
NPI:1063701993
Name:SIAKEL, SALLY A (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:SIAKEL
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 JAMESTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3235
Mailing Address - Country:US
Mailing Address - Phone:225-924-3000
Mailing Address - Fax:225-924-3030
Practice Address - Street 1:4637 JAMESTOWN AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3235
Practice Address - Country:US
Practice Address - Phone:225-924-3000
Practice Address - Fax:225-924-3030
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1435101YP2500X
LA425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist