Provider Demographics
NPI:1598391104
Name:PRIBLE, MICHELE (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:PRIBLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1838
Mailing Address - Country:US
Mailing Address - Phone:317-313-1436
Mailing Address - Fax:
Practice Address - Street 1:819 E 64TH ST STE 238
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-6609
Practice Address - Country:US
Practice Address - Phone:317-561-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002097A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist