Provider Demographics
NPI:1255512950
Name:ECKLEY, BETH ANN
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:ECKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:GROOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 GOLFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3953
Mailing Address - Country:US
Mailing Address - Phone:724-815-3479
Mailing Address - Fax:
Practice Address - Street 1:5 GOLFWOOD DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3953
Practice Address - Country:US
Practice Address - Phone:724-815-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2752101YM0800X
PAPC004620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
14280747OtherCAQH