Provider Demographics
NPI:1740708742
Name:ECKERT COUNSELING CENTER
Entity type:Organization
Organization Name:ECKERT COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:423-240-4885
Mailing Address - Street 1:3421 DAYTON BLVD
Mailing Address - Street 2:ROOTS COUNSELING CENTER
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415
Mailing Address - Country:US
Mailing Address - Phone:423-682-8402
Mailing Address - Fax:
Practice Address - Street 1:3421 DAYTON BLVD
Practice Address - Street 2:ROOTS COUNSELING CENTER
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415
Practice Address - Country:US
Practice Address - Phone:423-682-8402
Practice Address - Fax:423-682-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2515103TC0700X
TN2500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty