Provider Demographics
NPI:1598520793
Name:RIEBE, MADISON (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:RIEBE
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 3RD ST N STE 208
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5445
Mailing Address - Country:US
Mailing Address - Phone:651-327-0849
Mailing Address - Fax:651-383-4557
Practice Address - Street 1:7835 3RD ST N STE 208
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5445
Practice Address - Country:US
Practice Address - Phone:651-327-0849
Practice Address - Fax:651-383-4557
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health