Provider Demographics
NPI:1265972988
Name:LENK, EDEN (LCPC)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:LENK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 W SUMMERDALE AVE
Mailing Address - Street 2:APT. 1A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2150
Mailing Address - Country:US
Mailing Address - Phone:630-728-0351
Mailing Address - Fax:
Practice Address - Street 1:4840 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7860
Practice Address - Country:US
Practice Address - Phone:773-907-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health