Healthcare Provider Details

I. General information

NPI: 1689728255
Provider Name (Legal Business Name): JODY LEE EBERT MS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W JACKSON RD
CARROLLTON TX
75006-1316
US

IV. Provider business mailing address

3103 AMBER FOREST TRL
BELTON TX
76513
US

V. Phone/Fax

Practice location:
  • Phone: 972-242-2182
  • Fax:
Mailing address:
  • Phone: 254-613-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007652
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007021398
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: