Active NPI
Charles Cleary Eckelman, PH.D.
- Clinical Psychologist
- Clayton, MO
National Provider Identifier
1285755652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- R0044
- Practice address
- 225 S Meramec Ave
Suite 421T
Clayton, MO 63105-3511 - Phone
- (314) 721-6555
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | R0044 | MO | Primary |
Addresses
Primary practice location
225 S Meramec Ave
Suite 421T
Clayton, MO 63105-3511
Mailing address
259 Papin Ave
Webster Groves, MO 63119-3715
Phone (314) 968-9942
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0044 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285755652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "259 PAPIN AVE",
"city": "WEBSTER GROVES",
"state": "MO",
"postal_code": "631193715",
"telephone_number": "314-968-9942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 S MERAMEC AVE",
"address_2": "SUITE 421T",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631053511",
"telephone_number": "314-721-6555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ECKELMAN",
"first_name": "CHARLES",
"middle_name": "CLEARY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "R0044",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clayton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.