Provider Demographics
NPI:1619650967
Name:EIDI, LENA
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:EIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FOOTHILL CT NE APT 106
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-2088
Mailing Address - Country:US
Mailing Address - Phone:419-205-5733
Mailing Address - Fax:
Practice Address - Street 1:16535 SW TV HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-5143
Practice Address - Country:US
Practice Address - Phone:971-999-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health