Provider Demographics
NPI:1275047516
Name:EICHLER, LAICEE (CADCII, QMHAI)
Entity type:Individual
Prefix:
First Name:LAICEE
Middle Name:
Last Name:EICHLER
Suffix:
Gender:F
Credentials:CADCII, QMHAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97458-1449
Mailing Address - Country:US
Mailing Address - Phone:971-341-9264
Mailing Address - Fax:
Practice Address - Street 1:1741 NEWMARK AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4704
Practice Address - Country:US
Practice Address - Phone:541-756-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-23
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
OR19-12-19101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)