MEDICARE: MS. RACHEL LYNN ECCLES MA LPCC-S

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	101YM0800X	Mental Health Counselor	E1100640	OH
2	101YP2500X	Professional Counselor	C.1100640	OH
3	101YM0800X	Mental Health Counselor	E.1100640.SUPV	OH

General Provider Information

NPI Number	:	1982944781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL LYNN ECCLES MA LPCC-S

Provider Business Mailing Address
First Line	:	615 DELMAR PL
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41014-1457
Country	:	US
Telephone Number	:	513-276-6901
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 GLENMORE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211
Country	:	US
Telephone Number	:	513-231-6631
Fax Number	:

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

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	06/14/2018

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