Provider Demographics
NPI:1023035631
Name:ECK, VERA CLEMENT (MFT)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:CLEMENT
Last Name:ECK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 26TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3084
Mailing Address - Country:US
Mailing Address - Phone:310-493-1553
Mailing Address - Fax:
Practice Address - Street 1:1452 26TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3084
Practice Address - Country:US
Practice Address - Phone:310-493-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist