Provider Demographics
NPI:1225662083
Name:EDEN EMAN COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:EDEN EMAN COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:FORTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:901-827-7956
Mailing Address - Street 1:7600 CABOT DR APT 115
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4381
Mailing Address - Country:US
Mailing Address - Phone:901-827-7956
Mailing Address - Fax:
Practice Address - Street 1:4235 HILLSBORO PIKE STE 333
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3344
Practice Address - Country:US
Practice Address - Phone:901-827-7956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty