Provider Demographics
NPI:1619069234
Name:ECKENWILER, JOHN (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ECKENWILER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CO
Mailing Address - Zip Code:80118-8502
Mailing Address - Country:US
Mailing Address - Phone:303-267-2282
Mailing Address - Fax:303-681-3687
Practice Address - Street 1:9226 TEDDY LN
Practice Address - Street 2:150
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6725
Practice Address - Country:US
Practice Address - Phone:303-267-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist