Provider Demographics
NPI:1689728255
Name:EBERT, JODY LEE (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:LEE
Last Name:EBERT
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 AMBER FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513
Mailing Address - Country:US
Mailing Address - Phone:254-613-4158
Mailing Address - Fax:
Practice Address - Street 1:1100 W JACKSON RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1316
Practice Address - Country:US
Practice Address - Phone:972-242-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007652101YP2500X
MO2007021398101YP2500X
TX68084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional