Provider Demographics
NPI:1033447024
Name:KECKLER, WADE THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:THOMAS
Last Name:KECKLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:NAVAL HOSPITAL PENSACOLA
Mailing Address - Street 2:6000 WEST HIGHWAY 98
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0001
Mailing Address - Country:US
Mailing Address - Phone:850-452-5270
Mailing Address - Fax:850-452-5269
Practice Address - Street 1:NAVAL HOSPITAL PENSACOLA
Practice Address - Street 2:6000 WEST HIGHWAY 98
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0001
Practice Address - Country:US
Practice Address - Phone:850-452-5270
Practice Address - Fax:850-452-5269
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical