Provider Demographics
NPI:1417659582
Name:PRIEBE, KYTANA (MA, ATR-BC, LCPAT)
Entity Type:Individual
Prefix:
First Name:KYTANA
Middle Name:
Last Name:PRIEBE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 4TH ST SW APT 108
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2346
Mailing Address - Country:US
Mailing Address - Phone:319-899-8067
Mailing Address - Fax:
Practice Address - Street 1:11140 ROCKVILLE PIKE STE 602
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3184
Practice Address - Country:US
Practice Address - Phone:301-591-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC335101YM0800X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health