Healthcare Provider Details

I. General information

NPI: 1831826510
Provider Name (Legal Business Name): ADAM COLLIE ECCLESTON LPC-ASSOCIATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 JERSEY DR
AUSTIN TX
78758-3645
US

IV. Provider business mailing address

1508 JERSEY DR
AUSTIN TX
78758-3645
US

V. Phone/Fax

Practice location:
  • Phone: 512-656-9447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number86466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: