Healthcare Provider Details

I. General information

NPI: 1336459098
Provider Name (Legal Business Name): DAWN M ECKERT MA, LMHC, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N HARRISON ST ATTN: ANNE LAWSON
WARSAW IN
46580
US

IV. Provider business mailing address

850 N HARRISON ST ATTN: ANNE LAWSON
WARSAW IN
46580
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-7169
  • Fax: 574-268-2377
Mailing address:
  • Phone: 574-267-7169
  • Fax: 574-268-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002422A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001412A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: