Provider Demographics
NPI:1144660473
Name:ECCKER, JASON (LCSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ECCKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 CLIFTON AVE UNIT 5177
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-4004
Mailing Address - Country:US
Mailing Address - Phone:314-252-0174
Mailing Address - Fax:314-219-4591
Practice Address - Street 1:2702 MACKLIND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1406
Practice Address - Country:US
Practice Address - Phone:314-252-0174
Practice Address - Fax:314-219-4591
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140044021041C0700X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health