Provider Demographics
NPI:1700975679
Name:ECKER, KAY ELAINE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:ELAINE
Last Name:ECKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 WOOD DUCK CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5231
Mailing Address - Country:US
Mailing Address - Phone:209-478-3546
Mailing Address - Fax:209-478-3013
Practice Address - Street 1:2155 W MARCH LN
Practice Address - Street 2:SUITE 2B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6420
Practice Address - Country:US
Practice Address - Phone:209-473-4211
Practice Address - Fax:209-478-3013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist