Provider Demographics
NPI:1649289919
Name:ECKHOLDT, CHRISTOPHER SCOTT (PHD, MP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:ECKHOLDT
Suffix:
Gender:M
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 MAGNATE DR.
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3840
Mailing Address - Country:US
Mailing Address - Phone:337-889-5830
Mailing Address - Fax:337-889-5834
Practice Address - Street 1:93 MAGNATE DR.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3840
Practice Address - Country:US
Practice Address - Phone:337-889-5830
Practice Address - Fax:337-889-5834
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA837103T00000X
LAMP0837103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1007846Medicaid
LA1007846Medicaid