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General NPI Number Information
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NPI Number | 1760197339
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Entity Type | Individual
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Provider Name | BENJAMIN JOEL ERNSBERGER
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Gender | Male
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 2236 E MITCHELL RD # 5
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City | PETOSKEY
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State | MI
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Zip | 49770-9604
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Country | US
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Telephone | 231-939-1045
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Fax |
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Provider Business Mailing Address
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Address Line | 723 HIGH ST APT 1
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City | MARQUETTE
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State | MI
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Zip | 49855-3719
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Country | US
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Telephone | 231-939-1045
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6451022702
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | MI
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