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General NPI Number Information
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NPI Number | 1710261797
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Entity Type | Individual
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Provider Name | DAVID EBELING LMHC
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Gender | Male
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 2617 JUAN TABO BLVD NE STE AD
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2966
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Country | US
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Telephone | 505-295-3159
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Fax | 505-266-2502
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Provider Business Mailing Address
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Address Line | 508 TENNESSEE ST NE APT D
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2356
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Country | US
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Telephone | 505-331-9549
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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 | CMH0152191
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License Number State | NM
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