Provider Demographics
NPI:1649949843
Name:EBY, DANIEL VICTOR (LADC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:VICTOR
Last Name:EBY
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 FRANCE AVE S STE 425
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1808
Mailing Address - Country:US
Mailing Address - Phone:651-783-2069
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 425
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1808
Practice Address - Country:US
Practice Address - Phone:651-783-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304244101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)