Provider Demographics
NPI:1073086757
Name:EDEN, NATALIE (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:EDEN
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CRESCENT PARK
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2217
Mailing Address - Country:US
Mailing Address - Phone:847-341-8019
Mailing Address - Fax:
Practice Address - Street 1:315 2ND AVE STE 207
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2439
Practice Address - Country:US
Practice Address - Phone:847-341-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008572101YP2500X
IL180.009760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional