Provider Demographics
NPI:1790921369
Name:ECKLEY, KORTNEY D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KORTNEY
Middle Name:D
Last Name:ECKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507-1 GENTILE CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-4406
Mailing Address - Country:US
Mailing Address - Phone:219-331-9251
Mailing Address - Fax:
Practice Address - Street 1:5 WASHINGTON ST
Practice Address - Street 2:SUITE 350
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4768
Practice Address - Country:US
Practice Address - Phone:219-331-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-01
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005536A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical