Provider Demographics
NPI:1801025655
Name:WEST, EDEN MARIE (PCSW)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:MARIE
Last Name:WEST
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:EDEN
Other - Middle Name:MARIE
Other - Last Name:HINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 GILLETTE AVE.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3741
Mailing Address - Country:US
Mailing Address - Phone:307-685-6982
Mailing Address - Fax:307-685-8054
Practice Address - Street 1:113 S GILLETTE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3740
Practice Address - Country:US
Practice Address - Phone:307-685-6982
Practice Address - Fax:307-685-8054
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW 734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health