Provider Demographics
NPI:1285831024
Name:EBEN, MYRA HOPE (NCC,LPN,LPC)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:HOPE
Last Name:EBEN
Suffix:
Gender:F
Credentials:NCC,LPN,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 S MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-5129
Mailing Address - Country:US
Mailing Address - Phone:605-359-3241
Mailing Address - Fax:
Practice Address - Street 1:5000 S MINNESOTA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2707
Practice Address - Country:US
Practice Address - Phone:605-271-1348
Practice Address - Fax:605-610-1477
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC1165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional