MEDICARE: DANIEL R ELLENBERG MA, NCC, LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	285543	KY

General Provider Information

NPI Number	:	1801573001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL R ELLENBERG MA, NCC, LPCA

Provider Business Mailing Address
First Line	:	378 MEADOWCREST DR
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42503-6245
Country	:	US
Telephone Number	:	606-383-1189
Fax Number	:	866-359-0287

Provider Business Practice Location Address
First Line	:	3085 S HIGHWAY 27 STE 1
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42501-3013
Country	:	US
Telephone Number	:	859-414-6111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	01/02/2026

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