Provider Demographics
NPI:1366543704
Name:EBERSTEN, THOMAS KENNETH (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:KENNETH
Last Name:EBERSTEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16800 LAKESIDE CT
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:98241
Mailing Address - Country:US
Mailing Address - Phone:760-288-2711
Mailing Address - Fax:
Practice Address - Street 1:68625 PEREZ RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7250
Practice Address - Country:US
Practice Address - Phone:760-863-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical