Provider Demographics
NPI:1821166182
Name:SECKLER, PHILIP MARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MARK
Last Name:SECKLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 SW 54TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-6464
Mailing Address - Country:US
Mailing Address - Phone:561-512-8401
Mailing Address - Fax:
Practice Address - Street 1:8420 SW 54TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-6464
Practice Address - Country:US
Practice Address - Phone:561-512-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical