Provider Demographics
NPI:1598918534
Name:EBBERS, JOEL BENJAMIN DAVID (LLMSW)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:BENJAMIN DAVID
Last Name:EBBERS
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 CENTURY LN STE 50
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4393
Mailing Address - Country:US
Mailing Address - Phone:616-566-0588
Mailing Address - Fax:
Practice Address - Street 1:499 CENTURY LN STE 50
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4393
Practice Address - Country:US
Practice Address - Phone:616-566-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI68010965681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator