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General NPI Number Information
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NPI Number | 1366088239
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Entity Type | Individual
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Provider Name | KARLI ICEMAN
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Gender | Female
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 245 BARCLAY CIR STE 400
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5812
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Country | US
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Telephone | 313-626-0938
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Fax |
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Provider Business Mailing Address
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Address Line | 45925 SPRING LN APT 103
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48317-4857
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Country | US
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Telephone | 248-860-1908
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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 | 6401017146
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License Number State | MI
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