Provider Demographics
NPI:1598818544
Name:MATTHEWS, EDEN M (LPC, LMHC, CAP, ACAP)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:M
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LPC, LMHC, CAP, ACAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-0941
Mailing Address - Country:US
Mailing Address - Phone:251-269-5936
Mailing Address - Fax:251-974-3113
Practice Address - Street 1:307 S MCKENZIE ST STE 111
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1947
Practice Address - Country:US
Practice Address - Phone:251-269-5936
Practice Address - Fax:251-974-3113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2967101YP2500X
FLCAP 3205101YA0400X
AL1114101YA0400X
FLMH 10898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL360310501Medicaid