Nicole Siegel, LCSW, LCDC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

57444 Issued in TX

Practice address

2485 E Southlake Blvd Ste 180
Southlake, TX 76092-6687

Phone

(682) 593-1272

Fax

(817) 488-9697

NPI assigned

Aug 11, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Full Circle Therapy Center, PLLC

  • Clinical Social Worker
  • Southlake, TX
  • NPI 1578011458
  Medicare reassignment NPD Authorized official
• Heritage Behavioral Health Center

  • Clinical Social Worker
  • Southlake, TX
  • NPI 1053545509
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493164800000",
    "number": "1194134528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4142 PETERSBURG DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444373",
            "telephone_number": "682-593-1272",
            "fax_number": "817-488-9656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2485 E SOUTHLAKE BLVD STE 180",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926687",
            "telephone_number": "682-593-1272",
            "fax_number": "817-488-9697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEGEL",
        "first_name": "NICOLE",
        "credential": "LCSW, LCDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-11",
        "last_updated": "2017-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "11330",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "57444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiana Shivers, LPC
• Joshua Shoffit
• Anna Maria Shute, FNP-BC
• Talaya Marie Sibley
• Mohammad Zia Siddiqui, MD
• Sierra Op TX, LLC
• Silverlake Professional Group
• Silverstone Harborchase Southlake Operating, LLC
• Brooke V. Simer, MA, CCC-SLP
• Savannah Simerly

• Clinical Social Worker in Southlake, TX
• Providers in Southlake, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.