Provider Demographics
NPI:1922143692
Name:PECKSKAMP, EVELYN BYRD (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:BYRD
Last Name:PECKSKAMP
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3642 MARBURG AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1611
Mailing Address - Country:US
Mailing Address - Phone:513-470-4547
Mailing Address - Fax:
Practice Address - Street 1:5134 CEDAR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3717
Practice Address - Country:US
Practice Address - Phone:513-229-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0007947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional