Healthcare Provider Details

I. General information

NPI: 1629306105
Provider Name (Legal Business Name): CHANTELLE ALOHA ECKERT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2009
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 DELAWARE LN
VANCOUVER WA
98664-1408
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-566-4402
  • Fax:
Mailing address:
  • Phone: 360-397-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60469597
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: