Provider Demographics
NPI:1184903544
Name:EBERLE, JENNIFER (LPCC-S)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EBERLE
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 10TH ST SW STE 3
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-3906
Mailing Address - Country:US
Mailing Address - Phone:701-367-8293
Mailing Address - Fax:
Practice Address - Street 1:575 10TH ST SW STE 3
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3906
Practice Address - Country:US
Practice Address - Phone:701-367-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ND694-8-1-11A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND145374Medicaid