Provider Demographics
NPI:1083173785
Name:EBERT, ERIN K
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:K
Last Name:EBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 BURLESON RD APT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-5641
Mailing Address - Country:US
Mailing Address - Phone:512-387-0305
Mailing Address - Fax:
Practice Address - Street 1:4425 MOPAC EXPY S.
Practice Address - Street 2:BUILDING 3 SUITE 502
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-7873
Practice Address - Country:US
Practice Address - Phone:512-387-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62527104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker