MEDICARE: KARLI ICEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401017146	MI

General Provider Information

NPI Number	:	1366088239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLI ICEMAN

Provider Business Mailing Address
First Line	:	45925 SPRING LN APT 103
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-4857
Country	:	US
Telephone Number	:	248-860-1908
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 BARCLAY CIR STE 400
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5812
Country	:	US
Telephone Number	:	313-626-0938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	11/26/2019

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Directions to “ KARLI ICEMAN ” Practice Location

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