Provider Demographics
NPI:1962801555
Name:ECLOV, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ECLOV
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 1:6209 S PINNACLE PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3010
Mailing Address - Country:US
Mailing Address - Phone:605-988-8131
Mailing Address - Fax:605-988-8141
Practice Address - Street 1:6209 S PINNACLE PL
Practice Address - Street 2:SUITE 102
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3010
Practice Address - Country:US
Practice Address - Phone:605-988-8131
Practice Address - Fax:605-988-8141
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health