Provider Demographics
NPI:1720268782
Name:RYBERG, CARRIE L (MA, LCPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:L
Last Name:RYBERG
Suffix:
Gender:F
Credentials:MA, LCPC, NCC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:O'KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCPC, NCC
Mailing Address - Street 1:528 STREAMSTONE LN
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-1538
Mailing Address - Country:US
Mailing Address - Phone:618-477-1331
Mailing Address - Fax:618-566-0030
Practice Address - Street 1:1670 ESSEX WAY
Practice Address - Street 2:SUITE A103
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3063
Practice Address - Country:US
Practice Address - Phone:618-589-8850
Practice Address - Fax:618-589-8851
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008471101YP2500X
WARC00054786101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.008471OtherLICENSE NUMBERG
IL1720268782OtherNPI