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General NPI Number Information
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NPI Number | 1033791777
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Entity Type | Individual
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Provider Name | CAROLYN PRIEBE
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Gender | Female
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1550 E BELTLINE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4301
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Country | US
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Telephone | 616-765-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 E BELTLINE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451023840
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451023840
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License Number State | MI
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