Healthcare Provider Details

I. General information

NPI: 1508147364
Provider Name (Legal Business Name): HEATHER FRIEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CEDAR ST
STANDISH MI
48658-9421
US

IV. Provider business mailing address

201 MULHOLLAND ST
BAY CITY MI
48708-7693
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-4573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401006509
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: