Provider Demographics
NPI:1326612003
Name:MALES, EDEN CHARISSE (LCSW-S)
Entity Type:Individual
Prefix:MRS
First Name:EDEN
Middle Name:CHARISSE
Last Name:MALES
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 OWENS LN
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-2006
Mailing Address - Country:US
Mailing Address - Phone:512-652-8401
Mailing Address - Fax:
Practice Address - Street 1:13740 RESEARCH BLVD STE N7
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1834
Practice Address - Country:US
Practice Address - Phone:512-333-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical