Healthcare Provider Details

I. General information

NPI: 1164515748
Provider Name (Legal Business Name): CORINNE R RIEBOW MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 NORTH US HIGHWAY 231
SPENCER IN
47460
US

IV. Provider business mailing address

645 SOUTH ROGERS
BLOOMINGTON IN
47403
US

V. Phone/Fax

Practice location:
  • Phone: 812-829-4871
  • Fax: 812-337-2259
Mailing address:
  • Phone: 812-339-1691
  • Fax: 812-337-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001803A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: