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General NPI Number Information
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NPI Number | 1700613478
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Entity Type | Individual
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Provider Name | AUDREY ANNE EBERHARDT LPA
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Gender | Female
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 15252 SADDLEWOOD DR
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City | CONROE
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State | TX
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Zip | 77384-3453
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Country | US
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Telephone | 281-800-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 6 RAVEN RIDGE LN
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City | SPRING
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State | TX
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Zip | 77380-1830
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Country | US
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Telephone | 936-827-6162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39429
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License Number State | TX
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