Healthcare Provider Details

I. General information

NPI: 1689012379
Provider Name (Legal Business Name): BOBBI EBSEN PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
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 Number6801085914
License Number StateMI

VIII. Authorized Official

Name: KRISTI EBSEN
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LMSW, LCSW
Phone: 510-391-4099