Provider Demographics
NPI:1184106031
Name:EYKELBOSCH, MATTHEW ALAN (MS, MDIV, LPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:EYKELBOSCH
Suffix:
Gender:M
Credentials:MS, MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 6TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-5943
Mailing Address - Country:US
Mailing Address - Phone:541-622-2085
Mailing Address - Fax:
Practice Address - Street 1:310 E 6TH ST STE 202
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5943
Practice Address - Country:US
Practice Address - Phone:541-622-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health