Basic Information
| Provider Information | |||||||||
| NPI: | 1609253640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECKART | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LADC US | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9714 NE 3RD PL | ||||||||
| Address2: | |||||||||
| City: | MIDWEST CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731303515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056696454 | ||||||||
| FaxNumber: | 4052392637 | ||||||||
| Practice Location | |||||||||
| Address1: | 1737 LINWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731065037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052396815 | ||||||||
| FaxNumber: | 4052392637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2015 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.