Provider Demographics
NPI:1578866521
Name:ECKER, LISA L (SSW, MASTER'S INTERN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:ECKER
Suffix:
Gender:F
Credentials:SSW, MASTER'S INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 N MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1465
Mailing Address - Country:US
Mailing Address - Phone:801-779-0095
Mailing Address - Fax:
Practice Address - Street 1:1771 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1465
Practice Address - Country:US
Practice Address - Phone:801-779-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5809028-3503101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor