MEDICARE: DR. BRYAN CAMPBELL ECKERT PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	878	LA

General Provider Information

NPI Number	:	1073631966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN CAMPBELL ECKERT PSY.D.

Provider Business Mailing Address
First Line	:	7341 JEFFERSON HWY
Second Line	:	SUITE I
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-8203
Country	:	US
Telephone Number	:	225-927-7778
Fax Number	:	225-927-7771

Provider Business Practice Location Address
First Line	:	7341 JEFFERSON HWY
Second Line	:	SUITE I
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-8203
Country	:	US
Telephone Number	:	225-927-7778
Fax Number	:	225-927-7771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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