Provider Demographics
NPI:1962838797
Name:ECKELS, BRADLEY ADAM (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ADAM
Last Name:ECKELS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-4025
Mailing Address - Country:US
Mailing Address - Phone:724-433-1477
Mailing Address - Fax:
Practice Address - Street 1:310 CENTRAL CITY PLZ
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6441
Practice Address - Country:US
Practice Address - Phone:724-355-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPCOO7029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional