Active NPI
Lizabeth M. Eckerd, PH.D.
- Clinical Psychologist
- Medford, OR
National Provider Identifier
1275929630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2559
- Practice address
- 4497 Brown Ridge Ter Ste 106
Medford, OR 97504-9173 - Phone
- (502) 938-4723
- NPI assigned
- Apr 13, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1716 | KY | |
| Clinical Psychologist | 103TC0700X | 2559 | OR | Primary |
Addresses
Primary practice location
4497 Brown Ridge Ter Ste 106
Medford, OR 97504-9173
Mailing address
4497 Brown Ridge Ter Ste 106
Medford, OR 97504-9173
Phone (502) 938-4723
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500695711 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1716 | KY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620864000000",
"number": "1275929630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4497 BROWN RIDGE TER STE 106",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975049173",
"telephone_number": "502-938-4723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4497 BROWN RIDGE TER STE 106",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975049173",
"telephone_number": "502-938-4723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ECKERD",
"first_name": "LIZABETH",
"middle_name": "M.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-13",
"last_updated": "2021-05-13",
"certification_date": "2021-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KY",
"license": "1716",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2559",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500695711",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.