Provider Demographics
NPI:1871943886
Name:EBENSTEIN, TINA FAY (LPCC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:FAY
Last Name:EBENSTEIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-1429
Mailing Address - Country:US
Mailing Address - Phone:502-538-1000
Mailing Address - Fax:
Practice Address - Street 1:60 BENNETT CIR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2842
Practice Address - Country:US
Practice Address - Phone:606-878-1692
Practice Address - Fax:606-862-9334
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health