Provider Demographics
NPI:1811138464
Name:TRIEBOLD, CARL (LCPC, CRC)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:TRIEBOLD
Suffix:
Gender:M
Credentials:LCPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-0525
Mailing Address - Country:US
Mailing Address - Phone:800-874-3265
Mailing Address - Fax:
Practice Address - Street 1:451 CASS ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-2938
Practice Address - Country:US
Practice Address - Phone:800-874-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional