Healthcare Provider Details

I. General information

NPI: 1295914059
Provider Name (Legal Business Name): C. SCOTT ECKHOLDT, PH.D., LTD., A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KALISTE SALOOM RD
LAFAYETTE LA
70508-4210
US

IV. Provider business mailing address

800 KALISTE SALOOM RD
LAFAYETTE LA
70508-4210
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-2400
  • Fax: 337-232-3656
Mailing address:
  • Phone: 337-233-2400
  • Fax: 337-232-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number837MP
License Number StateLA

VIII. Authorized Official

Name: DR. CHRISTOPHER SCOTT ECKHOLDT
Title or Position: OWNER/PRESIDENT
Credential: PH.D., MP.
Phone: 337-546-6280