Provider Demographics
NPI:1023689718
Name:TRYBA, KATIE ROSE (LPC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ROSE
Last Name:TRYBA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 KARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3890
Mailing Address - Country:US
Mailing Address - Phone:920-659-1234
Mailing Address - Fax:
Practice Address - Street 1:5541 US HIGHWAY 10 E STE 10
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8306
Practice Address - Country:US
Practice Address - Phone:920-733-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10645-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional