Provider Demographics
NPI:1396129706
Name:EBERT, KARA DANIELLE (LMFT, PMH-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:DANIELLE
Last Name:EBERT
Suffix:
Gender:F
Credentials:LMFT, PMH-C
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:DANIELLE
Other - Last Name:MOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2163 US HIGHWAY 8 STE 100-4041
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-8326
Mailing Address - Country:US
Mailing Address - Phone:612-226-8719
Mailing Address - Fax:651-666-1762
Practice Address - Street 1:2724 STILLWATER ST
Practice Address - Street 2:
Practice Address - City:WHITE BEAR TOWNSHIP
Practice Address - State:MN
Practice Address - Zip Code:55110-2468
Practice Address - Country:US
Practice Address - Phone:612-226-8719
Practice Address - Fax:651-666-1762
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1205441391Medicaid