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General NPI Number Information
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NPI Number | 1326524380
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Entity Type | Individual
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Provider Name | KATHRYN EKLUND
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1041 JOHN SIMS PKWY E
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City | NICEVILLE
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State | FL
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Zip | 32578-2712
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Country | US
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Telephone | 850-389-8489
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Fax |
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Provider Business Mailing Address
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Address Line | 627 CHAMOMILE CT
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City | NICEVILLE
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State | FL
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Zip | 32578-3439
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Country | US
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Telephone | 253-666-2772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 724
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY12464
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License Number State | FL
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