Provider Demographics
NPI:1841452828
Name:EBEL, JODINE M (LAC)
Entity type:Individual
Prefix:
First Name:JODINE
Middle Name:M
Last Name:EBEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16351 I94
Mailing Address - Street 2:HOME ON THE RANGE
Mailing Address - City:SENTINEL BUTTE
Mailing Address - State:ND
Mailing Address - Zip Code:58654-9500
Mailing Address - Country:US
Mailing Address - Phone:701-872-3745
Mailing Address - Fax:701-872-3748
Practice Address - Street 1:16351 I94
Practice Address - Street 2:HOME ON THE RANGE
Practice Address - City:SENTINEL BUTTE
Practice Address - State:ND
Practice Address - Zip Code:58654-9500
Practice Address - Country:US
Practice Address - Phone:701-872-3745
Practice Address - Fax:701-872-3748
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1584101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND75006Medicaid