Healthcare Provider Details

I. General information

NPI: 1982944781
Provider Name (Legal Business Name): RACHEL LYNN ECCLES MA LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 GLENMORE AVE
CINCINNATI OH
45211
US

IV. Provider business mailing address

615 DELMAR PL
COVINGTON KY
41014-1457
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-6631
  • Fax:
Mailing address:
  • Phone: 513-276-6901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1100640
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1100640
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1100640.SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: