Healthcare Provider Details

I. General information

NPI: 1033791777
Provider Name (Legal Business Name): CAROLYN PRIEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date: 09/16/2024
Reactivation Date: 09/26/2024

III. Provider practice location address

1550 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4301
US

IV. Provider business mailing address

1550 E BELTLINE AVE SE
GRAND RAPIDS MI
49506-4301
US

V. Phone/Fax

Practice location:
  • Phone: 616-765-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023840
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023840
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: