Provider Demographics
NPI:1417546946
Name:EICKE, JEREMY (LPC, LCDC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:EICKE
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 LAZY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-2917
Mailing Address - Country:US
Mailing Address - Phone:972-533-7620
Mailing Address - Fax:
Practice Address - Street 1:648 LAZY RIVER DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-2917
Practice Address - Country:US
Practice Address - Phone:972-533-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13876101YA0400X
TX79619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)