Provider Demographics
NPI:1376420893
Name:EBINGER, KENNETH GEORGE (LAC, LPCC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GEORGE
Last Name:EBINGER
Suffix:
Gender:M
Credentials:LAC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40035
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-0035
Mailing Address - Country:US
Mailing Address - Phone:609-384-1763
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 40035
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-0035
Practice Address - Country:US
Practice Address - Phone:609-384-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0023303101YM0800X
COACD.0002799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty