Healthcare Provider Details

I. General information

NPI: 1659820462
Provider Name (Legal Business Name): EMILY ECCLES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 STATE ST
SANTA BARBARA CA
93101-2536
US

IV. Provider business mailing address

PO BOX 90814
SANTA BARBARA CA
93190-0814
US

V. Phone/Fax

Practice location:
  • Phone: 805-617-3835
  • Fax:
Mailing address:
  • Phone: 805-617-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: