Provider Demographics
NPI:1275929630
Name:ECKERD, LIZABETH M (PHD)
Entity Type:Individual
Prefix:
First Name:LIZABETH
Middle Name:M
Last Name:ECKERD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4497 BROWN RIDGE TER STE 106
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9173
Mailing Address - Country:US
Mailing Address - Phone:502-938-4723
Mailing Address - Fax:
Practice Address - Street 1:4497 BROWN RIDGE TER STE 106
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9173
Practice Address - Country:US
Practice Address - Phone:502-938-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1716103TC0700X
OR2559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500695711Medicaid