Healthcare Provider Details

I. General information

NPI: 1801308523
Provider Name (Legal Business Name): KRISTEN NICOLLE EIBEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 16TH ST
WYANDOTTE MI
48192-3344
US

IV. Provider business mailing address

1506 16TH ST
WYANDOTTE MI
48192-3344
US

V. Phone/Fax

Practice location:
  • Phone: 248-504-7094
  • Fax: 313-380-3435
Mailing address:
  • Phone: 248-504-7094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801106372
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801106372
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: