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NPI Code Detail

MEDICARE: DR. KEITH DAVID EICHE PH.D.

MEDICARE: DR. KEITH DAVID EICHE PH.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
1103TC0700XClinical Psychologist001226AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
150507OTHERNATIONAL REGISTER NUMBER

General Provider Information

NPI Number : 1609856483
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH DAVID EICHE PH.D.
Provider Business Mailing Address
First Line : 1850 W REPUBLIC RD
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-5730
Country : US
Telephone Number : 844-501-8387
Fax Number :
Provider Business Practice Location Address
First Line : 1850 W REPUBLIC RD
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-5730
Country : US
Telephone Number : 844-501-8387
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 09/03/2019

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