Provider Demographics
NPI:1578874020
Name:GECKLER, JAMES M (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:GECKLER
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LENNON ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1913
Mailing Address - Country:US
Mailing Address - Phone:508-971-7795
Mailing Address - Fax:
Practice Address - Street 1:750 EAST AVE UNIT 2E
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6259
Practice Address - Country:US
Practice Address - Phone:401-400-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
RIMHC00562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor