Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6301014122 | MI |
N | 103T00000X | Psychologist | 6301014122 | MI |
N | 102L00000X | Psychologist | 6301014122 | MI |
N | 103T00000X | Psychologist | 6301014122 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301014122 | MI |
N | 103TA0700X | Adult Development & Aging Psychologist | 6301014122 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301014122 | MI |
Y | 103G00000X | Clinical Psychologist | 6301014122 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301014122 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301014122 | MI |
N | 103TF0000X | Family Psychologist | 6301014122 | MI |
N | 103TP0814X | Psychoanalysis | 6301014122 | MI |
N | 103TP2701X | Group Psychotherapist | 6301014122 | MI |
N | 103TS0200X | School Psychologist | 6301014122 | MI |
NPI | 1598096281 |
---|---|
Provider Name | Thomas Eckert |
First Address | Saint Clair Shores, MI 48080-1447 |
Second Address | Saint Clair Shores, MI 48080-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2010 |
Last Update Date | 20/01/2010 |