Provider Demographics
NPI:1750886222
Name:NEAR, SAVANNAH EIDSON (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:EIDSON
Last Name:NEAR
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:SHAY
Other - Last Name:EIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6119 GREENVILLE AVE # 625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6119 GREENVILLE AVE # 625
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1910
Practice Address - Country:US
Practice Address - Phone:214-478-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health