Healthcare Provider Details

I. General information

NPI: 1558545954
Provider Name (Legal Business Name): KRISTI K EBSEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BOBBI EBSEN LCSW

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 RIO GRANDE BLVD NW STE A
ALBUQUERQUE NM
87104-3233
US

IV. Provider business mailing address

2501 RIO GRANDE BLVD NW STE A
ALBUQUERQUE NM
87104-3233
US

V. Phone/Fax

Practice location:
  • Phone: 510-391-4099
  • Fax: 510-328-7386
Mailing address:
  • Phone: 510-391-4099
  • Fax: 510-328-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0352
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096616-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW117521
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22990
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085914
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: