Provider Demographics
NPI:1336144435
Name:EICHENBERGER, ROBERT (DMIN, LPC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:EICHENBERGER
Suffix:
Gender:M
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E BROADWAY
Mailing Address - Street 2:STE 305
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6082
Mailing Address - Country:US
Mailing Address - Phone:573-443-4422
Mailing Address - Fax:573-443-4422
Practice Address - Street 1:2100 E BROADWAY
Practice Address - Street 2:STE 305
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6082
Practice Address - Country:US
Practice Address - Phone:573-443-4422
Practice Address - Fax:573-443-4422
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106746OtherBLUE CROSS BLUE SHIELD