Individual
DR. ELLEN R VAN ECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5015 BIRCH STREET, NEWPORT BEACH, CA 92660-2162
(949) 887-4166
Mailing address
5015 BIRCH STREET, NEWPORT BEACH, CA 92660-2162
(949) 887-4166
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
21511
CA
103TC1900X
Counseling Psychologist
21511
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21511
LICENSE
CA
Enumeration date
08/06/2007
Last updated
09/05/2019
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