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General NPI Number Information
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NPI Number | 1205466125
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Entity Type | Individual
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Provider Name | MICHAEL PROEBSTLE MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 4141 OLD SIBLEY MEMORIAL HWY
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City | EAGAN
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State | MN
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Zip | 55122-1996
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Country | US
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Telephone | 612-888-3858
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Fax |
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Provider Business Mailing Address
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Address Line | 3763 DENMARK TRL W
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City | EAGAN
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State | MN
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Zip | 55123-1010
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Country | US
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Telephone | 612-888-3858
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2310
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License Number State | MN
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