Provider Demographics
NPI:1386978856
Name:ECKER, RANDY (BS AAPS)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:ECKER
Suffix:
Gender:M
Credentials:BS AAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N HYDRAULIC ST STE 700
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4297
Mailing Address - Country:US
Mailing Address - Phone:316-558-3066
Mailing Address - Fax:316-558-3067
Practice Address - Street 1:140 N HYDRAULIC ST STE 700
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4297
Practice Address - Country:US
Practice Address - Phone:316-558-3066
Practice Address - Fax:316-558-3067
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07100901101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20060412AMedicaid