Provider Demographics
NPI:1942485362
Name:PT PRIEBE, PLLC
Entity Type:Organization
Organization Name:PT PRIEBE, PLLC
Other - Org Name:PAMELA T PRIEBE, LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:PRIEBE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:936-689-3256
Mailing Address - Street 1:84 OAK GROVE LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2515
Mailing Address - Country:US
Mailing Address - Phone:936-689-3256
Mailing Address - Fax:936-788-1100
Practice Address - Street 1:1110 N LOOP 336 W
Practice Address - Street 2:STE 250
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1194
Practice Address - Country:US
Practice Address - Phone:936-689-3256
Practice Address - Fax:936-788-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127370806Medicaid