Provider Demographics
NPI:1407011406
Name:ECKLER, JOHANNA WILSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:WILSON
Last Name:ECKLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 RAE DELL AVE
Mailing Address - Street 2:PCT (116B)
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4735
Mailing Address - Country:US
Mailing Address - Phone:512-660-1853
Mailing Address - Fax:855-700-9866
Practice Address - Street 1:1901 S 1ST ST
Practice Address - Street 2:PCT (116B)
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-743-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical