Provider Demographics
NPI:1417565011
Name:WITTERS, EDEN (RBT)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:WITTERS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41769 ENTERPRISE CIR N STE 104
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5626
Mailing Address - Country:US
Mailing Address - Phone:951-303-8255
Mailing Address - Fax:951-719-3429
Practice Address - Street 1:41769 ENTERPRISE CIR N STE 104
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5626
Practice Address - Country:US
Practice Address - Phone:951-303-8255
Practice Address - Fax:951-719-3429
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-20-115215106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician