Provider Demographics
NPI:1164968723
Name:ECKOLS, JENNIFER (LPC-S)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ECKOLS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 HAVELOCK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2227
Mailing Address - Country:US
Mailing Address - Phone:210-559-2240
Mailing Address - Fax:
Practice Address - Street 1:9111 HAVELOCK ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2227
Practice Address - Country:US
Practice Address - Phone:210-559-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional