Provider Demographics
NPI:1649298662
Name:EBLING, JOHN LAWRENCE (ACSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:EBLING
Suffix:
Gender:M
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196 E STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9267
Mailing Address - Country:US
Mailing Address - Phone:812-325-5843
Mailing Address - Fax:
Practice Address - Street 1:839 AUTO MALL RD
Practice Address - Street 2:SUITE H
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401
Practice Address - Country:US
Practice Address - Phone:812-334-1131
Practice Address - Fax:812-336-2925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001616A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical