Provider Demographics
NPI:1851751879
Name:ECKMAN, TRAVIS
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:ECKMAN
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 1:627 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4717
Mailing Address - Country:US
Mailing Address - Phone:209-723-6559
Mailing Address - Fax:209-723-7432
Practice Address - Street 1:2460 INDIA HOOK RD STE 104
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3530
Practice Address - Country:US
Practice Address - Phone:803-366-6250
Practice Address - Fax:615-577-5654
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health