Healthcare Provider Details

I. General information

NPI: 1467390252
Provider Name (Legal Business Name): ANGELA EBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 25TH AVE S STE 102
SAINT CLOUD MN
56301-4820
US

IV. Provider business mailing address

600 25TH AVE S STE 102
SAINT CLOUD MN
56301-4820
US

V. Phone/Fax

Practice location:
  • Phone: 320-406-1600
  • Fax:
Mailing address:
  • Phone: 320-406-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: