Healthcare Provider Details

I. General information

NPI: 1164077202
Provider Name (Legal Business Name): KIRSTEN J EBY ATR-BC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S INDIAN BEND RD
TEMPE AZ
85281-4926
US

IV. Provider business mailing address

1515 S INDIAN BEND RD
TEMPE AZ
85281-4926
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-5186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-18144
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: