Provider Demographics
NPI:1760839096
Name:EDEN COUNSELING CENTERS LLC
Entity Type:Organization
Organization Name:EDEN COUNSELING CENTERS LLC
Other - Org Name:EDEN COUNSELING CENTERS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR, BOARD OF DIRECTORS
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-398-3470
Mailing Address - Street 1:360 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5537
Mailing Address - Country:US
Mailing Address - Phone:614-398-3470
Mailing Address - Fax:
Practice Address - Street 1:360 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5537
Practice Address - Country:US
Practice Address - Phone:614-398-3470
Practice Address - Fax:614-340-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340106522084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150666Medicaid
OHH318930Medicare PIN