MEDICARE: DR. JOHANNA WILSON ECKLER 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	34024	TX

General Provider Information

NPI Number	:	1407011406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHANNA WILSON ECKLER PSY.D.

Provider Business Mailing Address
First Line	:	3005 S LAMAR BLVD
Second Line	:	STE D-109 #214
City	:	AUSTIN
State	:	TX
Zip	:	78704-4785
Country	:	US
Telephone Number	:	512-368-7784
Fax Number	:	512-646-4136

Provider Business Practice Location Address
First Line	:	3005 S LAMAR BLVD
Second Line	:	STE D-109 #214
City	:	AUSTIN
State	:	TX
Zip	:	78704-4785
Country	:	US
Telephone Number	:	512-368-7784
Fax Number	:	512-646-4136

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

Provider Enumeration Date	:	07/20/2008
Last Update Date	:	10/11/2024

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