Provider Demographics
NPI:1932231735
Name:EBBEN, PAUL ANTHONY (PSYD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANTHONY
Last Name:EBBEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PROGRESS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-8695
Mailing Address - Country:US
Mailing Address - Phone:502-848-0201
Mailing Address - Fax:502-848-0203
Practice Address - Street 1:106 PROGRESS DR
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-8695
Practice Address - Country:US
Practice Address - Phone:502-848-0201
Practice Address - Fax:502-848-0203
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0975103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0903801Medicare PIN
S17113Medicare UPIN