Provider Demographics
NPI:1528743408
Name:PEREBOOM, GABRIELLE MARILYN (TLMHC)
Entity type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:MARILYN
Last Name:PEREBOOM
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:MISS
Other - First Name:ELLIE
Other - Middle Name:MARILYN
Other - Last Name:PEREBOOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1630 42ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3063
Mailing Address - Country:US
Mailing Address - Phone:800-531-4236
Mailing Address - Fax:319-483-6661
Practice Address - Street 1:1630 42ND ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3063
Practice Address - Country:US
Practice Address - Phone:800-531-4236
Practice Address - Fax:319-483-6661
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health