Provider Demographics
NPI:1497038418
Name:EBISCH, ELLE P (MA, PLMHP)
Entity Type:Individual
Prefix:
First Name:ELLE
Middle Name:P
Last Name:EBISCH
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 DIVISION AVE
Mailing Address - Street 2:BOX 503
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1009
Mailing Address - Country:US
Mailing Address - Phone:402-362-3353
Mailing Address - Fax:402-362-3248
Practice Address - Street 1:2119 DIVISION AVE
Practice Address - Street 2:BOX 503
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1009
Practice Address - Country:US
Practice Address - Phone:402-362-3353
Practice Address - Fax:402-362-3248
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health