Provider Demographics
NPI:1992094809
Name:EBERHARDT, DAVID W (LMFT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:EBERHARDT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:ANOAH DAVID
Other - Middle Name:
Other - Last Name:EBERHARDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:4464 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4464 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5464
Practice Address - Country:US
Practice Address - Phone:385-240-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2949106H00000X
UT6118218-3902106H00000X
HIMFT-510106H00000X
OHF.0900005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist