Provider Demographics
NPI:1265800304
Name:ECKELBERRY, SCOTT ANDREW
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:ECKELBERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 STONE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-0431
Mailing Address - Country:US
Mailing Address - Phone:785-564-7208
Mailing Address - Fax:
Practice Address - Street 1:1106 N 155TH ST
Practice Address - Street 2:B
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-7100
Practice Address - Country:US
Practice Address - Phone:913-662-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48-1284001OtherCASE MAN./ CARE COORD.