Provider Demographics
NPI:1023210150
Name:EDER, STEVEN (MA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:EDER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 6TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2419
Mailing Address - Country:US
Mailing Address - Phone:541-963-6715
Mailing Address - Fax:541-962-7440
Practice Address - Street 1:1501 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2419
Practice Address - Country:US
Practice Address - Phone:541-963-6715
Practice Address - Fax:541-962-7440
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNR 5021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist