Michalene Marie Ebbert, M.A.,LPC.ALPS.RTT-S

Primary specialty

CounselorTaxonomy code 101Y00000X

License

836 Issued in WV

Practice address

234 Lee Ave
Nitro, WV 25143-2304

Phone

(304) 201-2095

Fax

(304) 201-2096

NPI assigned

Aug 25, 2015

Sex

Female

Sole proprietor

Yes

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.

• Damous Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Nitro, WV
  • NPI 1639665912
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Michalene Marie Petras Former name

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440460800000",
    "number": "1609243765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 D ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253033104",
            "telephone_number": "304-201-2095",
            "fax_number": "304-204-2096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 LEE AVE",
            "city": "NITRO",
            "state": "WV",
            "postal_code": "251432304",
            "telephone_number": "304-201-2095",
            "fax_number": "304-201-2096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBBERT",
        "first_name": "MICHALENE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "M.A.,LPC.ALPS.RTT-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-25",
        "last_updated": "2015-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WV",
            "license": "836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHALENE",
            "last_name": "PETRAS",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Nitro, WV
• Counselor in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.