Provider Demographics
NPI:1174242978
Name:ECKERT, NICHOLAS MYLES (RBT-22-225842)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MYLES
Last Name:ECKERT
Suffix:
Gender:M
Credentials:RBT-22-225842
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W WEATHERBEE RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6957
Mailing Address - Country:US
Mailing Address - Phone:772-203-4518
Mailing Address - Fax:
Practice Address - Street 1:1688 OLD CYPRESS TRAIL
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-214-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-225842106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician