Provider Demographics
NPI:1083797500
Name:WASHENBERGER, ELLEN C (LPCMH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:C
Last Name:WASHENBERGER
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 8TH AVE NW STE 321
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2700
Mailing Address - Country:US
Mailing Address - Phone:605-262-0513
Mailing Address - Fax:
Practice Address - Street 1:405 8TH AVE NW STE 321
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2700
Practice Address - Country:US
Practice Address - Phone:605-262-0513
Practice Address - Fax:605-252-0521
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH 2114101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575960Medicaid