Provider Demographics
NPI:1710261797
Name:EBELING, DAVID (LMHC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:EBELING
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 TENNESSEE ST NE APT D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2356
Mailing Address - Country:US
Mailing Address - Phone:505-331-9549
Mailing Address - Fax:
Practice Address - Street 1:2617 JUAN TABO BLVD NE STE AD
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2966
Practice Address - Country:US
Practice Address - Phone:505-295-3159
Practice Address - Fax:505-266-2502
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0152191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health