Provider Demographics
NPI:1174555908
Name:EDEN, DAVID M (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:EDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250
Mailing Address - Country:US
Mailing Address - Phone:360-378-9696
Mailing Address - Fax:360-378-3354
Practice Address - Street 1:55 SECOND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FRIDAY HR
Practice Address - State:WA
Practice Address - Zip Code:98250
Practice Address - Country:US
Practice Address - Phone:360-378-9696
Practice Address - Fax:360-378-3354
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004295103T00000X
WALF00000860103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00004295OtherLICENSED MENTAL HEALTH CO
WALF00000860OtherLICENSED MARRIAGE & FAMIL