| Doctor Name: | DR. WADE THOMAS KECKLER |
| NPI Number: | 1033447024 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 8045 |
| Business Practice Address: | 2817 Reilly St Bldg 4-2817 Fort Bragg, NC - 283107324 |
| Business Phone Number: | 9109076825 |
| Business Fax Number: | 9109078521 |
| Mailing Address: | 2817 Reilly St Bldg 4-2817, FORT BRAGG |
| State: | NC |
| Postal Code: | 283107324 |
| Phone Number: | 9109076825 |
| Fax Number: | 9109078521 |
| NPI Enumeration Date: | 12/02/2009 |
| NPI Last Update Date: | 03/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 8045 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |