Provider Demographics
NPI:1386234029
Name:EKKLESIA COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:EKKLESIA COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ECCLES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHCA
Authorized Official - Phone:317-840-8367
Mailing Address - Street 1:9511 ANGOLA CT STE 222
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1119
Mailing Address - Country:US
Mailing Address - Phone:317-840-8367
Mailing Address - Fax:
Practice Address - Street 1:9511 ANGOLA CT STE 222
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1119
Practice Address - Country:US
Practice Address - Phone:317-840-8367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty