Healthcare Provider Details

I. General information

NPI: 1417659582
Provider Name (Legal Business Name): KYTANA PRIEBE MA, ATR-BC, LCPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 ROCKVILLE PIKE STE 602
ROCKVILLE MD
20852-3184
US

IV. Provider business mailing address

1151 4TH ST SW APT 108
WASHINGTON DC
20024-2346
US

V. Phone/Fax

Practice location:
  • Phone: 301-591-6830
  • Fax:
Mailing address:
  • Phone: 319-899-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberATC335
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATC335
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: