Provider Demographics
NPI:1609128313
Name:KEVEN, EDAN MICHAEL
Entity Type:Individual
Prefix:MR
First Name:EDAN
Middle Name:MICHAEL
Last Name:KEVEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 N FRUIT AVE
Mailing Address - Street 2:APT N
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-3545
Mailing Address - Country:US
Mailing Address - Phone:559-498-9816
Mailing Address - Fax:
Practice Address - Street 1:2772 SOUTH MARTIN LUTHER KING BOULEVARD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706
Practice Address - Country:US
Practice Address - Phone:559-265-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)