Individual provider Active NPI

Pamela Ebert, LPCC-S

  • Mental Health Counselor
  • Canton, OH
National Provider Identifier
1467711580
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
E.1700159-SUPV Issued in OH
Practice address
4522 Fulton Dr NW
Canton, OH 44718-2332
Phone
(330) 915-2907
Fax
(330) 915-2958
NPI assigned
May 9, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X E.1700159-SUPV OH
Counselor 101Y00000X E.1700159-SUPV OH
Mental Health Counselor 101YM0800X E.1700159-SUPV OH Primary

Addresses

Primary practice location

4522 Fulton Dr NW
Canton, OH 44718-2332

Mailing address

4522 Fulton Dr NW
Canton, OH 44718-2332
Phone (330) 915-2907

Other practice location 1

5611 Hudson Dr Ste 400
Hudson, OH 44236-4452
Phone (330) 915-2907

Other practice location 2

4200 Munson St NW Ste A
Canton, OH 44718-2981
Phone (330) 915-2907

Other identifiers 1

IdentifierTypeStateIssuer
0215447MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240306002228 OH Practitioner - Mental Health Counselor 0547688616 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellness Grove LLCGroup PAC ID 5092104109, 25 clinicians

Practice addresses (Care Compare)

4522 Fulton Dr NW
Canton, OH 44718-2332
Phone (330) 915-2907

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wellness Grove, LLC Counselor CurrentSince Jan 16, 2024 Accepting new patients
Wellness Grove LLC Addiction (Substance Use Disorder) CurrentSince Jan 16, 2024 Accepting new patients

Locations

4200 Munson St NW
Ste A
Canton, OH 44718
Phone (330) 915-2907

4522 Fulton Dr NW
Canton, OH 44718
Phone (330) 915-2907

5611 Hudson Dr
Ste 400
Hudson, OH 44236
Phone (330) 915-2907

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768867200000",
    "number": "1467711580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4522 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182332",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4522 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182332",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5611 Hudson Dr Ste 400",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "OH",
            "postal_code": "442364452",
            "country_code": "US",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4200 Munson St NW Ste A",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447182981",
            "country_code": "US",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBERT",
        "first_name": "PAMELA",
        "name_prefix": "Dr.",
        "credential": "LPCC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-09",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1700159-SUPV",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "E.1700159-SUPV",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1700159-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0215447",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.