Provider Demographics
NPI:1003503301
Name:MCINTOSH, EDEN A (LPC)
Entity type:Individual
Prefix:MRS
First Name:EDEN
Middle Name:A
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 S 52ND LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2443
Mailing Address - Country:US
Mailing Address - Phone:480-709-8236
Mailing Address - Fax:
Practice Address - Street 1:5805 S 52ND LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2443
Practice Address - Country:US
Practice Address - Phone:480-709-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21044101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor