Provider Demographics
NPI:1932113529
Name:ECKENRODE, VANESSA SHANE (LCSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:SHANE
Last Name:ECKENRODE
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 1:206 DEEP DALE LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1249
Mailing Address - Country:US
Mailing Address - Phone:936-291-3391
Mailing Address - Fax:936-291-7622
Practice Address - Street 1:7517 STATE HIGHWAY 75 S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-2485
Practice Address - Country:US
Practice Address - Phone:936-291-3391
Practice Address - Fax:936-291-7622
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical