Provider Demographics
NPI:1114713823
Name:SEIBERT, JORDAN MATTHEW (LPC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MATTHEW
Last Name:SEIBERT
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 W HEMINGWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1733
Mailing Address - Country:US
Mailing Address - Phone:208-246-9475
Mailing Address - Fax:
Practice Address - Street 1:1014 W HEMINGWAY BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1733
Practice Address - Country:US
Practice Address - Phone:208-246-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7671157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional