Healthcare Provider Details

I. General information

NPI: 1275149478
Provider Name (Legal Business Name): BRANDON MATTHEW ECKSTEIN CT, CDCA, QMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N PROSPECT ST
BOWLING GREEN OH
43402-1335
US

IV. Provider business mailing address

3909 WOODLEY RD
TOLEDO OH
43606-1169
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-5387
  • Fax:
Mailing address:
  • Phone: 419-725-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2406411
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: