Provider Demographics
NPI:1770258089
Name:ECCLES, RALPH DAVID
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:DAVID
Last Name:ECCLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13016 SW BRIANNE WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-0673
Mailing Address - Country:US
Mailing Address - Phone:303-726-6320
Mailing Address - Fax:
Practice Address - Street 1:1219 SE LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3802
Practice Address - Country:US
Practice Address - Phone:503-765-5733
Practice Address - Fax:971-244-8583
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health