Provider Demographics
NPI:1578508826
Name:KUEBLER, CARMEN (LLP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:KUEBLER
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21751 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1846
Mailing Address - Country:US
Mailing Address - Phone:313-291-7000
Mailing Address - Fax:
Practice Address - Street 1:21751 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1846
Practice Address - Country:US
Practice Address - Phone:313-291-7000
Practice Address - Fax:313-291-0942
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009022103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301009022OtherLICENSE