Provider Demographics
NPI:1245626381
Name:EDEN, NAOMI (LAMFT)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:EDEN
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 KILIAN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-1648
Mailing Address - Country:US
Mailing Address - Phone:320-333-2134
Mailing Address - Fax:
Practice Address - Street 1:1320 S FRONTAGE RD STE 200
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2481
Practice Address - Country:US
Practice Address - Phone:651-500-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist